Episodic memory, depressive symptoms, and functional disability in middle-aged and older Chinese adults: the moderating role of social participation trajectory

BackgroundDepressive symptoms, sleep disturbances, and functional disability are interrelated. However, the bidirectional pathways between depression, sleep disturbances, and disability in instrumental activities of daily living (IADLs) remain underexplored in China.ObjectiveWe aimed to examine the bidirectional longitudinal relationships between depression and disability in IADLs among older Chinese adults, with a focus on elucidating the mediating role of sleep disturbances in this dynamic interplay.MethodsThe study encompassed 2677 older adults who provided complete data at T1 (2015), T2 (2018), and T3 (2020) for the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression (CESD-10) scale, and a 6-item scale was used to measure disability in IADLs. Sleep disturbances were self-reported. Temporal associations between depressive symptoms and disability in IADLs as well as the longitudinal mediating effect of sleep disturbances were examined using a cross-lagged panel model.ResultsPrior depression significantly predicted subsequent disability in IADLs at T2 (β=0.070, P<.001) and T3 (β=0.074, P<.001), and prior disability in IADL predicted subsequent depression at T2 (β=0.094, P<.001) and T3 (β=0.100, P<.001). Additionally, the indirect effect of prior disability in IADLs on subsequent depression via sleep disturbances was statistically significant (β=0.062, SE=0.010, P<.001), with the mediation effect accounting for 50.41% of the total effect. In contrast, after accounting for this mediation, the direct effect of prior depression on subsequent disability in IADLs was not significant (β=0.009, SE=0.018, P=.61). Consequently, the impact of depression on disability in IADLs was fully mediated through sleep disturbances in this cohort of older Chinese adults.ConclusionsDepressive symptoms and disability in IADLs are bidirectionally linked, and sleep disturbances play a longitudinal mediating role in the bidirectional relationship among older Chinese adults. The potential longitudinal bidirectionality highlights the importance of sleep health for interventions on depression and functional disability in older adults.

Background: The potential association and underlying mechanisms between instrumental activities of daily living (IADL) and depressive symptoms in middle‐ and older‐aged adults remain unclear. This study explores the bidirectional relationship between IADL disability and depressive symptoms among Chinese middle‐aged and older adults and examines the mediating or moderating effects of self‐rated health (SRH) and age on this relationship.Methods: We used data from five waves (2011, 2013, 2015, 2018, and 2020) of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey. A total of 4830 participants aged 45 and older were included in the analysis. Longitudinal associations between IADL disability, SRH, and depressive symptoms were tested using cross‐lagged models to simultaneously evaluate the bidirectional association and the strength of the temporal association.Results: Among middle‐aged and older adults, there was a significant bidirectional longitudinal relationship between IADL disabilities and depressive symptoms. Higher levels of IADL disability predicted an increased risk of depressive symptoms and vice versa. SRH mediated the bidirectional relationship between IADL disabilities and depressive symptoms. Higher levels of IADL disability led to lower SRH, which further increased the risk of depressive symptoms and vice versa. Age moderated the cross‐lagged models, indicating that the effect of SRH on the bidirectional relationship between IADL disability and depressive symptoms was stronger in the middle‐aged group than that in the older group.Conclusion: The study results clarified the bidirectional relationship between IADL disability and depressive symptoms in middle‐aged and older adults. Healthcare providers can use the findings to design targeted interventions to address the decline in IADL function and potentially benefit mental health. Helping middle‐aged and older adults improve their SRH may interrupt the vicious cycle linking IADL disability and depressive symptoms, particularly in middle‐aged adults transitioning to old age.

The association between functional disability and depressive symptoms among older adults: Findings from the China Health and Retirement Longitudinal Study (CHARLS)

IntroductionBased on the data from the China Health and Retirement longitudinal study (CHARLS), we aimed to investigate the bidirectional relationship between depressive symptoms and functional disability.MethodsData were collected across 3 waves from 2013 to 2018. The activities of daily living (ADLs) and the instrumental activities of daily living (IADLs) scales were used to measure functional disability and the CESD-10 was used to measure depressive symptoms. Cross-lagged models were performed to examine cross effect between depressive symptoms and functional disability across three waves.ResultsData on 10,092(mean [SD] age, 61.98[8.44] years; 3764 females [37.30%]) and 10,180 participants (mean [SD] age, 62.01[8.46] years; 3788 females [37.21%]) in IADL sample and ADL sample were included in the analyses. For IADL disability, the cross-lagged model shows a bidirectional association across three waves; the multivariable GEE model revealed that changes in CESD-10 score across waves were associated with worse IADL disability (β ranges: 0.08–0.10) and vice versa, worsen of IADL disability ascending developing of CESD-10 score (β ranges: 0.09–0.10). For ADL disability, the cross-lagged model shows a bidirectional association across three waves; the multivariable GEE model revealed that changes of CESD-10 score across waves were associated with worse IADL disability (β ranges: 0.08–0.10) and vice versa, worsen of IADL disability ascending developing of CESD-10 score (β ranges: 0.09–0.10).DiscussionStudy findings underscore a significant bidirectional between depressive symptoms and functional disability in older adults. Thus, simultaneous intervention should be taken to manage the mutual development of functional disability and depression.

BackgroundPrevious studies have not investigated the association between medical insurance and instrumental activity of daily living (IADL) disability. To fulfill this research gap, this study aims to explore the association between Urban and Rural Resident Basic Medical Insurance (URRBMI) and IADL disability among middle-aged and older adults in China.MethodsThe data of this study were sourced from the 2018 wave of China Health and Retirement Longitudinal Study (CHARLS). Logit regression models were used to analyze the association between URRBMI and odds of suffering from IADL disability. Furthermore, we used IV-Probit regression model to address the potential endogeneity problem. Moreover, propensity score matching and generalized random forest model were employed to conduct robustness checks.ResultsThe logit regression results reveal that URRBMI participation was significantly related to reduced odds of suffering from IADL disability by 39.86% after adjusting for the control variables (p < 0.01). The results of IV-Probit estimation show that URRBMI was an exogenous variable. Further robustness checks reported similar estimation results. The results of heterogeneity analysis reveal that URRBMI produced a statistically stronger effect on IADL disability for the older adults (OR = 0.5815, p < 0.01) when compared with the middle-aged adults (OR = 0.5690, p < 0.05). The results of impact channel analysis indicate that physical exercise was a channel involving the effect of URRBMI on IADL disability.ConclusionThis study finds that the middle-aged and older adults who were covered by URRBMI had a reduced possibility of suffering from IADL disability when compared with those without URRBMI. Furthermore, it is found that URRBMI produced a statistically stronger effect on IADL disability for the older adults when compared with the middle-aged adults. Moreover, we obtain evidence indicating that physical exercise was a channel involving the effect of URRBMI on IADL disability.

Sarcopenia is associated with functional disability in older adults. However, no consistent conclusions have been reached considering the differences in the measurement and criteria of sarcopenia. We aimed to examine the association between sarcopenia status and functional disability based on China Health and Retirement Longitudinal Study (CHARLS). A nationally representative longitudinal study. Participants aged at least 60 years old from the CHARLS 2015y were included. Sarcopenia was assessed according to the Asian Working Group for Sarcopenia 2019 algorithm. The outcomes of this study were basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The logistic regression model was conducted to analyze the cross-sectional and longitudinal associations between sarcopenia status and ADLs and IADLs disability. In the cross-sectional study, 37.2% of the 6893 participants were defined as having sarcopenia. Any form of sarcopenia was associated with ADLs and IADLs disability. During three years of follow-up, 786 (16.5%) participants developed new-onset ADLs disability, and 980 (22.5%) participants developed new-onset IADLs disability. Compared with the no-sarcopenia, participants with possible sarcopenia (OR: 1.62, 95%CI: 1.34-1.95), sarcopenia (OR: 1.58, 95%CI: 1.18-2.11), or total sarcopenia (OR: 1.58, 95%CI: 1.34-1.88) had a higher risk of ADLs disability. While, the risk of IADLs disability for participants with possible sarcopenia (OR: 1.68, 95%CI: 1.41-2.00), sarcopenia (OR: 1.87, 95%CI: 1.40-2.51), or total sarcopenia (OR: 1.71, 95%CI: 1.45-2.00) was still significantly increased. With statistical interaction between sarcopenia status and residence or sex in ADLs and IADLs disability, older adults in urban, with ORs ranging from 2.14 to 2.44, were at a higher risk of functional disability than those in rural. Possible sarcopenia was associated with a much higher risk of ADLs disability (OR: 1.68, 95%CI: 1.26-2.25) in males and a higher risk of IADLs disability (OR: 1.98, 95%CI: 1.56-2.52) in females. Sarcopenia was associated with an increased risk of ADLs and IADLs disability among older Chinese adults. Even possible sarcopenia still significantly impacted ADLs and IADLs disability, and this association varied by sex and residence.

Frailty and activities of daily living (ADL) disability are common conditions among older population. Studies on the bidirectional relationship between frailty and ADL are limited. The current study examined the cross-sectional and longitudinal associations between frailty and ADL in middle-aged and older Chinese individuals. The data was collected through the China Health and Retirement Longitudinal Study (CHARLS), conducted in 2011, 2013, and 2015, encompassing 17,284 individuals aged ≥45 years. We excluded individuals without follow-up data. 2,631 participants finished the baseline survey. The definition of ADL disability encompasses difficulty in engaging in either basic activities of daily living (BADL) or instrumental activities of daily living (IADL). Frailty was assessed according to the Fried criteria. Logistic regression was utilized to examine odds ratios (ORs) and 95% confidence intervals (CIs) for assessing the cross-sectional relationships between ADL with frailty at baseline. The prediction effects were explored using Cox proportional hazards analysis, testing hazard ratios (HRs) and 95%CIs. In cross-sectional analysis, BADL [OR = 6.660 (4.519-9.815)], IADL [OR = 5.950 (4.490-7.866)], and ADL [OR = 5.658 (4.278-7.483)] exhibited significant associations with frailty; frailty demonstrated significant associations with BADL [OR = 6.741 (4.574-9.933)], IADL [OR = 6.042 (4.555-8.016)] and ADL [OR = 5.735 (4.333-7.591)]. In longitudinal analysis, IADL and ADL were significantly associated with frailty in participants without baseline frailty in the short-term period [IADL: HR = 1.971 (1.150-3.379), ADL: HR = 1.920 (1.146-3.215)], IADL exhibited a significant association with frailty in the long-term period [HR = 2.056 (1.085-3.895)]. There was no significant link observed between frailty and an elevated risk of disability onset in BADL, IADL and ADL during the short-term period. When considering the long-term perspective, frailty exhibited a significant association with an elevated risk of disability onset in BADL [HR= 1.820 (1.126-2.939)] and IADL [HR = 1.724 (1.103-2.694)]. In middle-aged and older adults, ADL and IADL disability predicted frailty after 2-year follow-up, IADL disability predicted frailty after 4-year follow-up. Moreover, frailty did not predict BADL, IADL and ADL disability after 2-year follow-up. However, frailty predicted BADL and IADL disability after 4-year follow-up.

BackgroundsLittle is known about the role of frailty in the recovery process of disability among older adults. We examined the association between frailty and recovery from activities of daily living (ADL) and instrumental ADL (IADL) disability among community-dwelling Chinese older adults.MethodsData were from the China Health and Retirement Longitudinal Study. Three waves were used. Participants ≥60 years, had frailty assessment at baseline, and had incident disability in ADL or IADL in 2013, and had disability assessment in 2015 were included. Recovery from ADL and IADL disability were used as outcome measure. Multivariable logistic regression was used to evaluate the potential association between frailty and recovery from ADL or IADL.ResultsWe included 516 and 598 participants in the ADL and IADL analysis, respectively. In total, 237 participants recovered from ADL disability and 293 recovered from IADL disability. Nearly half of the non-frail persons recovered from ADL disability, while less than one-quarter of the frail persons had recovery. Over half of the non-frail persons had IADL disability recovery, while only 30% of the frail recovered. After adjustment, the odds of recovery from ADL disability were 59% (95% confidence interval [CI]: 1, 83%) lower among frail participants than those who were non-frail; the odds of recovery from IADL disability were 52% lower among frail persons than those who were non-frail and the association did not reach statistical significance.ConclusionsFrailty is an independent predictor of poor recovery from disability among nondisabled community-dwelling older adults in China.

Longitudinal impact of metabolic syndrome and depressive symptoms on subsequent functional disability among middle-aged and older adults in China

Hip fractures pose a major public health burden in aging populations, driven by rising osteoporosis prevalence and demographic aging. In China, nearly 2 million new cases occurred in 2019, disproportionately affecting middle-aged and older women. Despite extensive research on biomedical risk factors, mechanistic links between Activities of Daily Living (ADL) disability and hip fractures remain unclear. This study aims to elucidate the relationship between ADL disability and hip fractures incidence among middle-aged and older adult individuals in China. Furthermore, it seeks to explore the potential mediating role of depressive symptoms in this association, thereby contributing to a deeper understanding of hip fracture risk determinants. This longitudinal analysis utilized data from the China Health and Retirement Longitudinal Study (CHARLS) covering the period from 2011 to 2015. The study involved 5,066 participants who had no pre-existing hip fractures at baseline. ADL functional capacity was assessed by categorizing Instrumental Activities of Daily Living (IADL) and Basic Activities of Daily Living (BADL). Depressive symptoms were measured using the Center for Epidemiological Studies Depression Scale (CES-D-10). The incidence of hip fractures was documented over a four-year follow-up period, and both logistic regression and mediation analyses were performed to investigate the associations. Within the follow-up cohort, a total of 256 incident hip fractures were recorded. After adjusting for confounding variables, IADL disability emerged as a significant predictor of fracture risk (OR = 1.42, 95% CI: 1.07-1.89, p = 0.017), while BADL disability was found to have an even greater impact (OR = 1.96, 95% CI: 1.47-2.61, p < 0.001). Mediation analysis indicated that depressive symptoms accounted for a substantial portion of the association, mediating 43.8% of the relationship between IADL disability and hip fractures risk, and contributing to 23.4% of the association between BADL disability and hip fractures. ADL disability, particularly BADL, independently predicts hip fractures in older Chinese adults. Depressive symptoms mediate 43.8% of the risk associated with IADL and 23.4% of the effect related to BADL. Therefore, integrating depression management into ADL-focused interventions may enhance strategies for fracture prevention.

Association between functional disability and long-term trajectories of depressive symptoms: Evidence from the China Health and Retirement Longitudinal Study

BackgroundThe prevalence of functional limitations is relatively high among the middle-aged and older adults. However, the contribution of functional limitations to subsequent incident cardiovascular diseases (CVD) and death is unclear. This study aims to examine the association between functional limitations and incident CVD and all-cause mortality among the middle-aged and older adults.MethodsThis is a nationally representative prospective cohort study. Participants were middle-aged and older Chinese adults from The China Health and Retirement Longitudinal Study. Functional limitations were measured using activities of daily living (ADL) scale and instrumental activities of daily living (IADL) scale. Incident CVD and death were recorded at followed-up from June 1, 2011, up until August 31, 2018. Cox proportional hazards model was used to assess the association between functional limitations and incident CVD and all-cause mortality.ResultsA total of 11,013 participants were included in this study. During the 7 years of follow-up, 1,914 incident CVD and 1,182 incident deaths were identified. Participants with functional limitations were associated with a 23% increased risk of incident CVD (HR, 1.23, 95% CI:1.08,1.39) after adjusting for age, gender, residential area, marital status, education, smoking, alcohol drinking, sleep duration, nap duration, depression symptoms, social participation, history of hypertension, diabetes, dyslipidemia, use of hypertension medications, diabetes medications, and lipid-lowering therapy. Moreover, participants with functional limitations were associated with a 63% increased risk of all-cause mortality (HR,1.63, 95%CI: 1.41,1.89) after adjusting for potential confounders.ConclusionsFunctional limitations were significantly associated with subsequent incident CVD and death among the middle-aged and older Chinese adults.

ObjectiveImpaired Activities of Daily Living (ADL) can have a negative impact on the psychological well-being of older adults. This study categorises ADL into Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL). By utilising nationally representative cross-sectional data, we explore the association between ADL and BADL limitations and depressive symptoms among the elderly population in China. In addition, this study explored the relationships between BADL, IADL and depression risk in elderly people at the individual and provincial levels and in rural and urban subgroups.MethodsThe China Health and Retirement Longitudinal Study(CHARLS) survey used a multistage probability‒proportional‒to-size (PPS) sampling technique. Province-level socioeconomic characteristics were merged with microdata for respondents over 60 years of age from the 2020 China Health and Retirement Longitudinal Study (CHARLS 2020) Wave 5 (n = 10,036) by the author. The respondents were asked whether their BADL and IADL were limited. The risk of depression was assessed using the 10-item Centre for Epidemiological Studies Depression Scale (CES-D 10). The chi-squared test was used to explore whether having a disability that limits BADL and IADL was associated with mental health status. A binary logistic regression model was used to evaluate this association further after controlling for confounding factors.ResultsOverall, 27.5% (2759/10036) and 25.7% (2776/10036) of the participants over 60 years of age were limited in their BADL and IADL, respectively. Regression analyses revealed that older adults whose BADL were not limited (OR = 1.942, 95% CI: 1.638–2.303, P <.001) and whose IADL were not limited (OR = 1.775, 95% CI: 1.485–2.122, P <.001) had a lower risk of depression than older adults whose BADL and IADL were limited. In addition, older adults who were female (P <.001), were 60–69 years (P <.005), had a partner (P <.001), were literate (P <.001), lived in a rural area (P <.001), had a retirement pension (P <.001), had three or more children (P <.001), did not have any chronic diseases (P <.001), had a fair SRH score (P <.001), drank alcohol (P <.001), exercised (P <.005), did not participate in social activities (P <.001), or had an above average per capita household consumption (P <.001) lived in provinces with the first quartile of GDP per capita (P <.001) and lived in provinces with the second quartile of the number of beds in medical institutions per 10,000 persons (P <.001) were more likely to experience depressive symptoms, while smoking had no effect. In a binary logistic regression, older adults who were single (OR = 0.669, 95% CI = 0.551, 0.812), illiterate (OR = 0.646, 95% CI = 0.504, 0.828), living in rural areas (OR = 1.485, 95% CI = 1.270, 1.735), without retirement pensions (OR = 0.671, 95% CI = 0.582, 0.819) and with very bad SRH scores (OR = 0.411, 95% CI = 0.311, 0.544) had a greater risk of depressive symptoms. In the binary logistic regression analysis of the urban and rural subgroups separately, the results indicated that old people whose BADL or IADL were not limited were associated with a risk of depression, especially rural (P <.001) and urban (P <.001) participants.ConclusionsThe present study provides evidence of an association between BADL, IADL and depression in older Chinese adults. This study revealed that individuals with limited BADL and limited IADL were predominantly depressed older adults. Binary logistic regression models suggested that disabilities limiting BADL and IADL were more likely to be associated with depressive symptoms in rural Chinese older adults. Findings underscore the need for targeted rural interventions (e.g., subsidised mobility aids and caregiver training) to mitigate depression risk.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40359-025-03223-9.

The mediating and moderating effects of depressive symptoms on the prospective association between cognitive function and activities of daily living disability in older adults

This study examined the longitudinal associations and mechanisms between Instrumental Activities of Daily Living (IADL) disability and depression among middle-aged and older adults. Using data from three waves (2015, 2018, 2020) of the China Health and Retirement Longitudinal Study (CHARLS), a cross-lagged model was employed. It revealed that IADL disability predicted depression, with life satisfaction as a mediator. Social participation trajectory moderated these longitudinal associations, with a higher trajectory reducing negative effects of IADL disability on depression by enhancing life satisfaction. The findings suggest that promoting social participation to improve life satisfaction may help prevent depression associated with IADL disability.