Intergenerational contact frequency and health outcomes among empty-nest older adults in China: a mediation analysis through physical exercise

This study examines the associations between intergenerational contact frequency and health outcomes among empty-nest older adults in China, and further investigates whether physical exercise serves as a behavioral pathway underlying these associations. Using data from the 2020 wave of the China Health and Retirement Longitudinal Study (CHARLS), we analyzed 3117 community-dwelling individuals aged 65 years and older who did not co-reside with their children. Intergenerational contact frequency was measured as a five-level ordinal indicator based on the frequency of in-person visits by children during the past year, using the maximum contact frequency across all children as the primary aggregation rule. Self-rated health and physical exercise frequency were analyzed using ordered logistic regression, while depressive symptoms measured by the CES-D-10 were modeled using negative binomial regression. Mediation effects were decomposed using the Karlson-Holm-Breen (KHB) method with 5000 bootstrap resamples. Higher intergenerational contact frequency was significantly associated with better self-rated health (OR = 1.18, 95% CI 1.10-1.27) and fewer depressive symptoms (IRR = 0.92, 95% CI 0.88-0.96), after adjusting for age, sex, education, residence, marital status, income, and chronic disease count. More frequent intergenerational contact was also positively associated with physical exercise frequency (β = 0.21, p < 0.001). Physical exercise partially mediated both associations. The indirect effect through exercise accounted for 18.6% of the association between intergenerational contact and self-rated health (indirect effect = 0.088, 95% CI 0.043-0.136), and 13.4% of the association with depressive symptoms (indirect effect = - 0.12, 95% CI - 0.20 to - 0.06). Subgroup analyses suggested that the mediating role of physical exercise was somewhat stronger among rural residents and male older adults. More frequent in-person contact between empty-nest older adults and their children is associated with better physical and mental health outcomes in China, with physical exercise partially explaining these associations. These findings suggest that intergenerational relationships may contribute to healthy aging partly by promoting more active lifestyles among older adults. Due to the cross-sectional design, causal relationships cannot be established. Longitudinal analyses using multiple waves of CHARLS data are needed to clarify temporal ordering and causal mechanisms. Public health strategies that integrate family engagement with community-based exercise promotion may help support healthy aging in China's growing empty-nest older population.