Social Participation and Self-Perception of Being Old in China

Abstract

Longer life expectancy means that chronological age is no longer a useful indicator of defining old age. This study included 6,452 participants aged 60 years and older from the 2014 China Longitudinal Aging Social Survey to investigate the relationships between different types of social participation and self-perception of being old in China. Ordinary least square regression was applied. Results show that respondents who engaged in political participation or community participation reported higher self-perception of being old than those who did not engage in these social participations. Respondents who provided more care for grandchildren reported self-perception of being old at younger age. In the context of delaying retirement in China, obligatory participation was associated with an earlier start of the self-perception of being old. Elimination of mandatory retirement and separating that from pension eligibility may be good choices for promoting active aging.

Keywords

self-perception of being old social participation older adults China

Introduction

China is experiencing an increase in the proportion of older adults that will put them on track to surpass the proportion in Western developed countries (Zimmer & Kwong, 2003). The average life expectancy in China has increased from 67.9 years to 76.5 years in the past 30 years (An, 2017). Longer life expectancy not only changes one’s chronological age but could also change one’s self-perception of being old. Although there is no agreed point at which a person becomes an older person, 60 or 65 years were the most used ages for eligibility of pension schemes, so that people would link retirement age with old age (Roebuck, 1979). The Chinese government sets the mandatory retirement age at 60 years for men, 55 years for female white-collar employees, and 50 years for female blue-collar workers. When individuals pass these thresholds, they are qualified to access a pension as their main source of income rather than still engaging in the labor force. However, there has been great debate about increasing the official retirement age in China (Hong, 2018). One major reason for supporting the delay of the retirement age is the lack of pension funds. Also, many scholars advocate for active aging and think it would be a big loss of human capital if the mandatory retirement age were set at age 55 or 60. However, those who are against the delay of the retirement age believe older adults may not be capable of working due to their increased loss of physical and cognitive capacity (Jia, 2013). There is a need to study the perception of being old, in order to shed light on this debate of retirement age. If such an increase in the retirement age were applied, what would be the age at which people considered themselves as older adults? Furthermore, what are the age-related factors that may serve as signals for a person’s perception of being old? This study will address these two questions. Self-perception of being old is used as an indicator of people’s view on being old, and social participation is the key age-related factor on which this study focuses.

Aging is a process shaped by dynamic interactions with social environments and cultural systems (Demakakos, Gjonca, & Nazroo, 2007; Karp, 1988). Researchers have attempted to identify potential factors related to perceived aging in the study of life course. In recent years, social participation, which is considered a pivotal element of successful aging, has been highlighted by the activity theory of aging. This theory states that well-being in old age is promoted by high levels of participation in social and leisure activities (Adams, Leibbrandt, & Moon, 2011). Social participation includes but is not limited to political participation, economic participation, community participation, and caring for grandchildren.

Political participation refers to involvement in activities mainly aimed at influencing political decision making in their living areas. People can gain a stronger voice and increase representation through political participation. Political participation can also help to avoid them becoming oppressed voices as an aspect of social exclusion of older adults (Kafkova, Vidovicova, & Wija, 2018).

Community participation refers to participation in the social and cultural aspects of communities. Community participation may increase the chance of social interaction with neighbors and support the maintenance of close relationships with mainstream society. In some studies, participating in community activities as a form of role change or social engagement was found to contribute to younger age perception (Atchley, 1994; Mutran & Reitzes, 1981). Active involvements in community activities can contribute to older adults’ self-perception of being old by helping them maintain middle-aged lifestyles as long as possible. In addition, it increases their ability to adapt to changes in their social environment and role transitions (Havighurst, 1961).

Economic participation refers to engagement in any form of paid work. Some studies have proposed that the construction of perceptions of old age should depend on socioeconomic status and revealed that higher social and economic status are associated with a younger subjective age (Kuper & Marmot, 2003; Peters, 1971; Toothman & Barrett, 2011; Yaghoobzadeh et al., 2018). Roles in work can influence self-perception of being old by shaping the rhythm of a person’s life course. In contrast, retirement may have an opposite effect on one’s self-perception of being old. Some studies suggested that retirement is associated with an identity of age (George, Mutran, & Pennybacker, 1980; Mutran & George, 1982; Peters, 1971; Ward, 1977), while Bordone, Arpino, and Rosina (2019) found that men feel old mainly when they retire. On the other hand, other studies did not find such a significant association when age and health were controlled (Logan, Ward, & Spitze, 1992; Mutran & Reitzes, 1981). Empirical evidence on the relationship between retirement and perception of being older is unclear.

Caring for grandchildren reflects interaction with family members. Number of children and care of grandchildren have been found to be positive factors in subjective age (Barak & Gould, 1985; Bastida, 1987). Researchers have found a cumulative negative association among older women between subjective age and both having grandchildren and providing grandchild care (Bordone & Arpino, 2016). Engaging in grandparenting as a form of social engagement is expected to be positively associated with views toward one’s own life. This is mainly because it can provide a sense of purpose and a form of daily activity (Kivnick, 1981).

It has also been argued that grandparenting can be a risk factor rather than beneficial to self-perception of being old, due to its inherent demands and pressures (Burn & Szoeke, 2015). The study of Kaufman and Elder (2003) confirmed that only those who enjoyed being a grandparent were more likely to feel younger and expected to live longer.

Mounting empirical evidence has confirmed that active participation in social activities is associated with various health outcome among older adults (Bourassa, Memel, Woolverton, & Sbarra, 2017; Croezen, Avendano, Burdorf, & vanLenthe, 2015; Morrow-Howell, Hinterlong, Rozario, & Tang, 2006; Tomioka, Kurumatani, & Hosoi, 2017; Zeng, Gu, & George, 2011), and that the association between social participation and depressive symptoms grows stronger with age (Ang, 2018). However, little is known about how social participation shapes self-perception of being old. We know surprisingly little about the nature of these conceptions, particularly how they are influenced by the social contexts in which our lives are embedded (Toothman & Barrett, 2011). Inconsistent findings in a very small number of studies conducted in Western countries reflect that the effect of social participation on perception of aging varies in different social and cultural contexts, which may be also attributed to different measures of age perception and social participation. In summary, no study has explored the relationship between social participation and self-perception of being old in China, particularly whether the association varies depending on types of engaged social activity within the context that cultural values and social systems substantially differ from Western societies.

Studies conducted in Western countries found that different life domains have been referred as being related to age stereotypes of men and women (Kornadt, Voss, & Rothermund, 2013). Based on traditional gender roles, men and women are expected to play different roles in housework-related and social activities which may lead to gender differences in the effect of social participation on self-perception of being old. Women were more likely to feel old than men, and they were more likely to think that society considers them old, while men felt old mainly when they retire (Bordone et al., 2019). There was a cumulative negative association between subjective age and both having grandchildren and providing grandchild care for older women (Bordone & Arpino, 2016). However, previous studies have also showed that the findings on the role of gender affecting the subjective perception of age are mixed. Barak and Rahtz (1999) did not find any sign of effects of gender on subjective age and likelihood of feeling older; women reported significantly more youthful identities than men when the following variables were controlled: health outcomes, levels of perceived control over their marriages/partnerships, and having older partners that all associated with older identities of women (Barrett, 2005). Inconsistent findings in gender differences may reflect cultural difference and differences in gender roles. To our knowledge, no study has examined gender differences in the relationship between social participation and self-perception of being old. It is important to understand that various social participation activities may have different impacts between men and women.

Therefore, the purpose of this study is to explore the age at which people consider themselves an older person (self-perception of being old) and to examine the association between social participation and self-perception of being old among older adults in China, by distinguishing different types of social participation. Gender differences in the self-perception of being old and their association with social participation are also investigated.

Research Design and Methods

Data

This study used the data from the first wave of the China Longitudinal Aging Social Survey (CLASS) conducted in 2014. The CLASS is a nationally representative survey of adults aged 60 years and older in China, and it was conducted by the National Survey Research Center at Renmin University of China. This survey used a stratified multistage sampling design and covered 462 communities within 28 provinces, municipalities and autonomous regions. A total of 11,511 respondents were interviewed as part of the survey. This study included a total of 6,452 participants who completed the data on self-perception of being old and social participation. Most of the excluded respondents were those who reported they could not answer these questions due to low cognitive function or low comprehension of the questions. Compared to those who completed the study, those who were excluded from the study were older, and a higher proportion were female residents of rural areas, with lower levels of education and income.

Table 1 shows the characteristics of the sample. The average age was 69 years (ranging between 60 and 97 years), with 54% male and over 70% married. The majority of the respondents (93.43%) were Han Chinese and almost 45% were rural residents. More than half of them had a lower education than middle school, and over 60% were farmers or employees. On average, participants had three living children. Over 70% of the respondents had at least one chronic disease and about 30% had two or more chronic diseases. Most respondents were able to manage their daily activities independently. In terms of gender differences among respondents, only the categories of age, race, and activities of daily living (ADL) did not exhibit significant differences. The female respondents were less likely to be married, less educated, included fewer residents of rural areas, and had lower annual personal income and fewer children on average. The percentage of older women with the occupation of manager or professional was also lower. In addition, older women reported worse health conditions including greater proportion of chronic diseases and lower level of instrumental activities of daily living (IADL).

Table 1.

Characteristics of the Sample and Gender Differences.

Variables	Whole samplePercentage/Mean (SD)	Older men(N = 3,935)	Older women(N = 3,353)
Age	69.02 (7.36)	68.91 (7.42)	69.14 (7.29)
Marital status (married)	71.16%	81.55%	58.96%***
Education			***
Illiterate	20.70%	11.61%	31.37%
Primary school	36.87%	39.16%	34.18%
Middle school	23.12%	26.89%	18.70%
High school and above	19.31%	22.34%	15.75%
Race (Han Chinese)	93.43%	93.14%	93.77%
Registered residence			*
Rural residence	45.53%	46.66%	44.20%
Urban residence	44.98%	44.65%	45.36%
Suburban residence	9.50%	8.69%	10.44%*
Occupation			**
Manager	8.78%	11.59%	5.49%
Professional	10.92%	12.27%	9.33%
Employee	27.57%	26.20%	29.17%
Farmer	41.36%	39.59%	43.42%
Else	11.39%	10.34%	12.62%
Personal income (RMB)	20,056.62 (23,106.29)	22,616.17 (26,246.33)	17,052.79 (18,315.76)***
Child number	2.78 (1.44)	2.73 (1.46)	2.83 (1.42)**
Number of chronic diseases	1.67 (1.73)	1.54 (1.66)	1.83 (1.79)***
Activities of daily living	17.86 (0.84)	17.86 (0.83)	17.85 (0.85)
Instrumental activities of daily living	19.13 (1.98)	19.24 (1.90)	18.99 (2.07)***
Political participation	49.99%**	51.64%	48.05%
Economic participation	21.20%	26.56%	14.91%***
Community participation	21.91%	21.30%	22.64%
Care for grandchildren	2.07 (2.93)	2.15 (2.99)	1.98 (2.87)**
Self-perception of being old	70.04 (9.82)	70.09 (9.87)	69.97 (9.77)

*p < .05. **p < .01. ***p < .001.

Measures

Dependent variables

Aging is a complicated concept due to cultural differences in vocabulary and meanings of the language of aging (Fick & Lundebjerg, 2017; Resnick, 2017). There are different subjective measures of aging. Some emphasized the perceived timing of old age (Kuper & Marmot, 2003), while others focused on self-perception of beliefs about aging (Bordone et al., 2019; Levy et al., 2016). Measures also varied between focusing on individual’s own personal life or on general social expectations for old people (Levy, Slade, Kunkel, & Kasl, 2002; Levy et al., 2016). In this study, self-perception of being old assessed respondents’ perceptions of their own personal age for being an old adult or the age at which they entered old age, which was shaped by both Chinese culture norms and their personal experience. The participants were asked, “At what age do you think you become an older individual?” Possible answers ranged from 20 to 110 years (mean = 70). A higher score indicates a higher age threshold of being old.

Independent Variables

Social participation

Social participation was assessed through four indicators from the CLASS. The first one is political participation, which was measured by the question, “Did you participate in any vote on a local community council or village committee in recent three years?” Economic participation is the second indicator, which was measured with the question, “Are you engaged in any paid work or activities?” The third one, community participation, was measured by participation in any volunteer work or charity activity at local communities in past three months. Volunteer works or charitable activities were defined in the following seven response categories: security patrol around the local community, helping older people with daily living and shopping, providing counselling services, reconciling arguments, environmental sanitation or protection activities, volunteering technical services, and caring for children from other households. Community participation was coded as 1 if the respondents answered Yes to at least one of these seven categories, and 0 otherwise. Since China has strong traditional values of family support and an underdeveloped social support system, caring for grandchild(ren) or helping with household chores is considered a very important way for older adults to make a contribution to the family and society. Hence, the fourth indicator for social participation is care for grandchildren. This category was measured by asking the respondents, “How often did you look after your grandchildren in the past 12 months?” for each adult child with at least one child younger than 18 years. Six responses were provided: Never or rarely = 0, At least once a month = 1, Several times a month = 2, At least once a week = 3, Every day but not the whole day = 4, and The whole day every day = 5. Participants would take care of multiple grandchildren at the same time. The maximum number of adult children with at least one child younger than 18 years in the CLASS dataset was 5. The score for care for grandchildren was constructed by summing the unweighted points from these questions. Scores ranges from 0 to 21, with a higher value representing more time spent caring for grandchildren.

Confounders

Health status and sociodemographic variables are considered potential confounders in this study. As people grow old, their physical functions are more likely to decline, and health-related problems may occur. Individuals most frequently cite declining physical functions and worsening health status as the reasons for beginning to feel old (Logan et al., 1992; Sherman, 1994). Therefore, health status was assessed by the number of chronic diseases, ADL, and IADL. The number of chronic diseases was measured by self-reported presence of the following chronic diseases: high blood pressure, diabetes, heart disease, stroke, cataracts or glaucoma, cancer or malignant tumor, bronchitis or other respiratory ailment, arthritis, rheumatism, stomach ailment such as an ulcer, osteoporosis, liver or gall bladder disease, kidney disease, memory-related disease (such as dementia and Parkinsonism), cervical or lumbar spondylosis, and nervous system diseases. A summary variable ranged from 0 to 15. ADL refers to the ability to perform a set of personal ADL, which was measured through six items (such as self-feeding, bathing, dressing, toileting, personal hygiene, and grooming and moving). A summary score was created with a higher score indicating a higher level of ADL (ranging from 6 to 18). IADL, which is measured through seven items (such as preparing dinner, doing house work, using the telephone, taking medicine by oneself, taking a bus or train by oneself, shopping by oneself, and managing money). The summary score for IADL ranged from 7 to 21, with a higher value representing better ability.

Socioeconomic status included educational achievement, occupation and individual income. Education was measured as the highest education level completed and divided into four categories: illiterate or no formal education, primary school, middle school, and high school or above. Occupation was measured by the last major career of respondents who were still working or who worked before. Responses were divided into five categories: managers, professionals, employees, farmers (including agriculture, animal husbandry, and fishery), and else (mainly including self-employed and the unemployed). Individual income was assessed by the total amount of earnings in last twelve months, including pensions, part-time income, and earnings from self-employed activities. It was transformed using ln+1 in regression models. Age, gender, race, marital status and registered residence were included in the analysis as demographic indicators. Age was treated as a continuous variable. Gender (male = 1, female = 0), race (Han Chinese = 1, non-Han Chinese = 0), and marital status (married = 1, others= 0) were coded as dichotomous variables. Registered residence was categorized into rural residence, urban residence, and suburban residence (to integrate the rural-urban division, the residence is no longer identified as rural residence or urban residence in some areas).

Statistical Analysis

We first compared the gender differences in the core variables, including social participation and self-perception of being old through t tests (for continuous variables) or Pearson’s χ² test (for categorical variables). Then, ordinary least squares (OLS) regression was applied to analyze the relationship between social participation and self-perception of being old. Analyses were conducted on the total sample and then stratified by gender. A baseline model was used to examine the association between potential confounders and self-perception of being old (Model 1), and social participation variables were added to the model (Model 2) to examine their associations with self-perception of being old after controlling confounders. All analyses were conducted using Stata 11 software.

Results

As Table 1 shows, self-perceived aging did not differ significantly by gender. For both older men and women, the mean age for self-perception of being old was about 70 years. Figure 1 further shows that the self-perception of being old was concentrated at age 60, 70, and 80 years. Although China’s government defines older people as those older than 60 years, less than 30% of respondents perceived that they began to be an older people at 60 years. Over 60% of respondents perceived that they began to be an older person at 70 years or older. Apart from community participation, there were significant gender differences for three types of social participation (shown in Table 1). Compared to their female counterparts, older men were more likely to engage in political participation, paid work, and providing care to grandchildren.

Figure 1.

Reported age of becoming an older person.

The associations between social participation and self-perception of being old were examined with an OLS regression, controlled for health conditions and sociodemographic characteristics (shown in Table 2). The regression estimates in Model 2 suggest that social participation was significantly associated with self-perception of being old, but that the association varied according to different types of social participation. Respondents who participated in political activities and community volunteering were associated with an older age at which they considered themselves to become older people than those who did not participate in political activities and community volunteering. In addition, individuals who provided care for their grandchildren were associated with feeling like they became older people at a younger age than those providing less care for grandchildren. There were no significant differences between individuals who engaged and did not engage in economic participation.

Table 2.

OLS Regression Results of Self-Perception of Being Old and Gender Differences.

Variables	Whole sample		Older men		Older women
Variables	Model 1	Model 2	Model 1	Model 2	Model 1	Model 2
Political participation (ref: No)		0.80***		0.68*		1.09**
Economic participation (ref: No)		−0.20		−0.01		−0.66*
Community participation (ref: No)		0.82**		1.24***		0.39
Care for grandchildren		−0.13**		−0.17**		−0.08
Number of chronic diseases	−0.49***	−0.51***	−0.51***	−0.53***	−0.47***	−0.48***
Activities of daily living	−0.24	−0.22	−0.18	−0.17	−0.29	−0.28
Instrumental activities of daily living	0.28***	0.26***	0.28*	0.27*	0.30**	0.27*
Gender (ref: Female)	−0.46*	−0.41	/	/		/
Age	0.43***	0.41***	0.39***	0.37***	0.47***	0.46***
Han-Chinese (ref: Minority)	0.58	0.66	1.49*	1.58**	−0.61	−0.52
Residence (ref: Rural)
Urban	0.35	0.51	0.78	0.95	−0.24	−0.17
Suburban	−0.41	−0.33	0.49	0.64	−1.43*	−1.47*
Married (ref: Others)	0.15	0.19	−0.39	−0.31	0.65	0.68
Education (ref: Illiterate)
Primary school	0.13	0.02	0.86	0.78	−0.28	−0.42
Middle school	1.58***	1.39***	2.10**	1.89**	1.39*	1.22*
High school and above	1.26**	1.12**	1.88**	1.72**	0.79	0.63
Occupation (ref: Farmers)
Manager	3.20***	3.15***	2.58***	2.58***	4.24***	4.10***
Professional	2.53***	2.56***	1.95**	2.05**	3.40***	3.38***
Employee	2.05***	2.03***	1.62**	1.69**	2.68***	2.57***
Else	2.10***	2.11***	1.68**	1.65**	2.56***	2.62***
Individual income (ln+1)	0.09	0.07	0.19	0.17	0.02	0.01
Child number	−0.36***	−0.29**	−0.26*	−0.20	−0.41**	−0.35*
R ²	.137	.144	.134	.140	.14	.156
F	64.51	54.55	35.19	29.82	34.66	28.84

*p < .05. **p < .01. ***p < .001.

Among the confounders, health conditions including chronic disease and IADL were significantly correlated to self-perception of being old. Individuals with higher level of educational attainment reported older self-perception of being old than those with lower level of educational attainment. Individuals who were at younger chronological age, farmers, and who had more children perceived themselves as being older at a younger age than those who were at older chronological age, whose occupation was something other than farming, and who had fewer children.

Table 2 also shows the gender differences in the OLS regression of social participation and self-perception of being old. Gender-specific analysis confirmed that there was a significant gender difference in the effect of social participation. The negative association between economic participation and self-perception of being old was significant among older women, and care for grandchildren was only negatively associated with self-perception of being old among older men. Among older men, participating as community volunteers was associated with a later self-perception of being old. There was a significant gender difference in some of the confounders. Race and education of higher school and above were significantly associated with older men’s self-perception of being old but not with older women’s, while suburban residence and number of children were significantly associated with older women’s self-perception of being old but not older men’s.

Discussion and Implications

Using a nationally representative sample and cross-sectional data, this study provides the first examination of the relationships between social participation and self-perception of being old in China. The results showed that social participation was significantly associated with self-perception of being old in China, but this association varied with different kinds of social participation. Older Chinese people who participated in political activities and community volunteering were more likely to report self-perception of being old at older age. However, negative associations were found between economic participation (women only), caring for grandchildren (both and or men only), and self-perceptions of being old, which suggests that older Chinese people who engaged in paid work or provided more care for their grandchildren reported self-perception of being old at younger age. The different association of social participation and self-perception of being old may be partially attributed to China’s underdeveloped social institutions and culture of filial piety. Unlike in Western societies, older Chinese people, especially residents of rural areas, often face financial hardship and are heavily dependent on their children for support, due to the absence of state-sponsored old-age assistance and the traditional culture of filial piety in China. To avoid being a big burden on their children, older people try to keep their financial independence as much as possible and provide child care support to their adult children as a reciprocal behavior. The findings imply that these kinds of social participation, namely economic participation and caring for grandchildren, may be mostly motivated by demand and responsibility rather than by their willingness to socially contribute. In many cases, older people are even physically or mentally challenged by engaging in these social participation activities. However, in terms of public activities, especially voluntary activities, individuals can fully make their own decisions on whether they participate in these activities based on their willingness, interests and abilities. Our findings show that there were various associations between different kinds of social participation and self-perception of being old. Our study further illustrates that obligatory participation (such as caring for grandchildren), which is often physically and mentally demanding, can be associated with an earlier start of self-perceptions of being old.

Our results also suggest that the association between social participation and self-perception of being old differed by gender. The negative association between care for grandchildren and self-perception of being old was only significant among older men, while participating in community volunteering was positively correlated to older men’s self-perception of being old. Economic participation was only associated with younger age of perceiving oneself as an older person among older women. Participating in political activities significantly correlated to both older men’s and older women’s self-perceptions of being old. One explanation for the gender difference is Chinese gender role norms. Under traditional gender norms, men play a key role in society while women are confined to family chores. Thus, in comparison to their counterparts, those older men who have to provide more care to their grandchildren and those older women who engage in paid work are expected to face more challenges in the society because their activities may be deviant from their traditional roles.

There were a few limitations in the study. One was the use of cross-sectional data which limits the ability to determine the causal relationship between social participation and self-perceptions of being old. Although nationally representative data were used in this study, a large percentage of respondents was excluded due to missing values in core variables, which may bias the estimations. In addition, self-perception of being old was only measured with a single item which may not fully capture the complicated meanings of perceived being old, and so there might have been nondifferential misclassification of this measure which would bias associations toward the null (Kuper & Marmot, 2003). CLASS only interviewed older people who were aged 60 years and older, while individuals in age between 50 and 60 years could be a future direction due to the mandatory retirement age in China starts from 50 years (for female blue-collar workers). Nevertheless, this article contributes an important perspective on the active aging during China’s social and demographic transition.

In conclusion, this is the first study on the relationship between social participation and self-perception of being old in China. The results show that chronological age was positively associated with self-perception of being old for both gender, and males and females separately. This reflects the role of chronological age in explaining views on when an individual joins the rank of the older generation. Our findings shed important light on the discussion related to delay of retirement age. The results suggest that the average age of self-perception of old age is 70 years in China, far beyond the mandatory retirement age. In particular, the findings show that obligatory participation (such as caring for grandchildren) was associated with an earlier start of the self-perception of old age. Voluntary retirement would be better to fit individuals’ needs. Therefore, elimination of mandatory retirement or a flexible program of delaying retirement age based on individual’s choices may be beneficial for individuals’ self-perceptions of being old; individuals could be encouraged to actively participate in public activities, especially voluntary activities based on their own willingness, interests, and abilities, in order to promote the strategy of active aging in China. Separating pension eligibility from mandatory retirement could also help to ensure individuals’ financial independence. In addition, gender-specific activities should be considered in promoting the strategy of active aging.

Footnotes

Acknowledgments

The data used in this study were from the China Longitudinal Aging Social Survey (CLASS) carried out in 2014. The data was originally collected by the National Survey Research Center at Renmin University of China. The authors appreciate the assistance in providing data by the center. The research findings are the product of the researchers. Neither the original collectors of the data nor the Archive bear any responsibility for the analyses or interpretations presented here.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Zhixin Feng

Author Biographies

Huijun Liu is a professor of the School of Public Policy and Administration, a researcher of the Center for Aging and Health Research, Xi’an Jiaotong University. Her research interests include gender imbalance and health risk, family structure, old-age support and health of rural elderly in China.

Bei Wu is an inaugural co-director of the Aging Incubator at New York University (NYU). She holds the position of dean’s professor in Global Health and director of Global Health and Aging Research at the NYU Rory Meyers College of Nursing. She is also the director of research at the Hartford Institute for Geriatric Nursing at NYU. Her program of research is on aging and health, with a particular focus on long-term care, dementia, caregiving, and oral health.

Zhixin Feng is a research fellow in School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton. He is also a visiting research fellow within Gerontology at the University of Southampton. His research interests are population health, health geography, health inequality and ageing both in the United Kingdom and China.

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