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Cognitive ability of elderly migrants needs better protection

JIAO CAN and FAN SHUMING | 2019-11-28
(Chinese Social Sciences Today)
Due to urbanization and the emergence of nuclear families, an increasing number of senior citizens have to migrate to major cities far from their hometowns to take care of their grandchildren. Photo: IC


Elderly migrants, often called “floating elderly” in Chinese, have become a hot topic as more and more elderly are leaving their hometowns and settling down near their children in cities as a part of the rapid process of urbanization. Most of the elderly migrants come to cities to help take care of their grandchildren. While getting to spend more time with their family, elderly migrants face difficulties in language, dining habits, customs and seeking medical treatment due to having remote medical insurance. 
According to the 2016 Report on China’s Migrant Population Development, there were nearly 18 million elderly migrants aged 60 or over who were staying where they were not registered and had been away from their registered residence for more than half a year, among which 43% were relocating to take care of their grandchildren. Then according to the latest report released by the National Health Commission on Jan. 24, 2019, the size of the elderly migrating population increased from 5.03 million in 2000 to 13.04 million in 2015, with an average annual growth rate of 6.6%. With the aggravation of an aging society and the increase of one-child families, more and more older adults will become floating elderly in the future, which calls for more attention from academics and the government.
As one gets older, brain and cognitive functions are expected to decline. Maladjustment caused by migration can accelerate the rate of cognitive decline in the elderly and increase the risk of cognitive impairment. 
Cognitive impairment refers to the impairment of cognitive functioning, which includes the ability of the human brain to process, store and extract information, such as memory, calculation, spatial-temporal orientation, executive ability, language understanding and expression. 
Cognitive impairment not only affects the quality of life of the elderly themselves, but also increases the burden on family and society. Therefore, it is of great practical significance to protect the cognitive functioning of elderly migrants during this wave of urbanization and aging. From this perspective, we can bring more attention to the cognitive health of elderly migrants, so as to promote healthy and active aging.
Worrisome status quo
To achieve the aforementioned goal, we’ve conducted a survey with elderly migrants in various communities in Shenzhen City. The respondents, all from different provinces and cities, followed their children to live in Shenzhen in order to take care of their children and grandchildren. 
A total of 436 people were surveyed, 171 males and 265 females. In terms of educational background, 152 of the total graduated from primary school, 187 middle school or secondary school, and 97 attended high school or higher education. The survey required the elderly to comprehend and complete the questionnaire independently, so the respondents did not include illiterate elderly.
We applied the Mini-Mental State Examination (MMSE) to measure the cognitive function of elderly migrants. The method has been widely recognized and applied at home and abroad, and the following seven aspects were investigated: time orientation, place orientation, instant recall, attention and calculation, delayed recall, language, and visuospatial ability. There were 30 questions in the scale, with each correct answer scoring 1 point, while the wrong answer or “I don’t know” scored 0 point. The total score ranged from 0 to 30 points. 
According to the recommendation published by the Shanghai Mental Health Center in 1990, cognitive impairment is defined by different criteria for the elderly with different education levels: ≤20 points for primary school and ≤24 points for middle school and above. 
After the initial MMSE screening, the results were as follows: 35 of the 152 elderly migrants with only primary school education were cognitively impaired, and 86 of the 284 elderly migrants with secondary school education or above were cognitively impaired. Among the 436 surveyed, 121 of them were cognitively impaired, with a cognitively impaired rate of 27%, far higher than 10.12%—the average rate of cognitive impairment among Chinese elderly over 60 as determined in research carried out by Chinese scholar Deng Qian in 2013. 
In this study, the average age of the elderly was younger and their region of habitation was more prosperous with supposedly better medical care, but the rate of cognitive impairment was higher. The reason for this gap was mainly due to the difference of research objects: elderly migrants and elderly residents who have been living in their residential community for more than 6 months. It can be seen that, compared with the ordinary older adults, the risk of cognitive impairment for elderly migrants is greater, so more measures should be taken to protect and intervene in the cognitive functioning of elderly migrants.
Mental health
In order to construct the mental health model of the cognitive function of elderly migrants, influencing factors were explored in the form of demographic variables such as gender, education level, and mental health indicators such as social support, loneliness and mental resilience. Comprehended social support is the social support that an individual feels. Loneliness refers to the lack of social contact and social isolation that an individual feels. Resilience refers to an individual’s ability to adapt to adversity, trauma, tragedy, threat or other major stresses.
The results showed that there were statistically significant differences in the cognitive functions of elderly migrants in terms of gender and education level. 
Male cognitive function was significantly higher than their female counterpart’s. Compared with men, women tend to do more housework and childcare, and their brains are relatively less used and stimulated, so their cognitive function may decline faster. 
The cognitive function of the educated elderly migrants was significantly higher than of those who received less education. Early literacy may have protected cognitive function by boosting the brain’s functional reserve. 
In addition, having an understanding of social support has a significant positive predictive effect on the cognitive function of the group. It can help the elderly to regulate stress, reduce cognitive resource consumption, and protect their cognitive functions. 
At the same time, compared with family support and important others such as relatives and former classmates, peer support has a greater impact on the cognitive function of elderly migrants. In the fast pace of big cities, children are usually busy with work and study and do not have enough time to accompany the elderly. Therefore, they need more social support from peer contact and communication to cope with the pressure of relocation and maintain their cognitive health.
In order to further explore the influence of social support on cognitive function, the structural equation modeling method was used to construct a mental health model to analyze the impact social support, loneliness and mental resilience have on the cognitive functions of elderly migrants. 
Among them, loneliness has a significant negative predictive effect, and it plays a mediating role in the influence of social support on the cognitive function. That means that social support plays a role in cognitive function partially through the feeling of loneliness. Mental resilience then plays a moderating role in understanding the impact of social support on loneliness and the impact of loneliness on cognitive function: The better mental resilience is, the greater the role of social support in reducing loneliness will be, and the smaller the role of loneliness in damaging cognitive function will be.
Effective measures
Based on the data analysis, we propose the following measures to protect the cognitive functions of elderly migrants. First, compared with that of male elderly migrants, the cognitive functioning of female migrants needs more attention. 
Second, we should carry out community education activities for the elderly to encourage them to continue their studies and enhance their cultural knowledge. 
Third, families and communities should provide practical support for elderly migrants. Attention should be paid to find out how the group truly feels and to help them understand that they are supported and cared for. On this basis, the negative feelings of loneliness can be resolved through family gatherings, communication and counseling.
Fourth, families and communities should help elderly migrants rebuild their social networks, encourage them to make friends in new environments and encourage them to get more peer support. 
Finally, more mental health lectures for elderly migrants should be conducted to provide the services and knowledge that they need to improve their mental resilience and health.
Jiao Can and Fan Shuming are from the School of Psychology at Shenzhen University.