Physical function, ADL, and depressive symptoms in Chinese elderly: Evidence from the CHARLS.

Background: Depressive symptoms are a serious public health problem that affects the mental health of older adults. However, current knowledge of the association between ADL disability and physical dysfunction and depressive symptoms in Chinese adults is insufficient. We intend to analyze the association between physical function, ADL, and depressive symptoms in older Chinese adults. Methods: The data obtained from the China Health and Retirement Longitudinal Survey (2015 and 2018) (CHARLS). This includes 3,431 in 2015 and 3,258 in 2018 over the age of 60. Comparing 2015 and 2018 data, multivariate logistic regression models were used to explore the relationship between physical function, ADL, and depressive symptoms in urban and rural older adults, adjusting for sociodemographic factors associated with depression in older adults. Results: The prevalence of depressive symptoms among older adults in China was 33.8 percent in 2015 and 50.6 percent in 2018. In baseline data from 2015 and 2018, residence, gender, marital status, drinking, physical function, ADL, and self-rated health were all found to be significantly associated with depressive symptoms in older adults. The differences in physical function, ADL and depressive symptoms among older adults in 2015 and 2018 were further analyzed based on urban and rural stratification. Both physical dysfunction and ADL disability were significantly associated with depressive symptoms in rural older adults in 2015 and 2018. And in urban areas, ADL was found to be significantly associated with depressive symptoms in urban older adults. Multivariate logistic regression analysis demonstrated that ADL disability was significantly associated with depressive symptoms among older adults in both urban and rural areas. Physical dysfunction was only significant in rural areas with depressive symptoms. The alpha level was instead set to 0.05 for all statistical tests. Conclusion: Rural, female, 60-70 years of age, primary school or below, married, non-smoking, non-drinking, physical dysfunction, ADL disability and self-rated poor health make-up a higher proportion of depressed older adults. ADL disability and physical dysfunction were more likely to be associated with depressive symptoms in rural Chinese older adults. Therefore, the physical and mental health of rural elderly should be of concern. The rural older adults should receive additional support from the government and society.

The impact of chronic diseases on depressive symptoms among the older adults: The role of sleep quality and empty nest status.

BACKGROUND: Depression is the most prevalent mental disorder among older adults. This study aimed to explore the mediating effect of sleep quality on the relationship between chronic diseases and depressive symptoms, and the moderating role of empty nest status in the mediating model. METHODS: A cross-sectional survey was conducted among 3637 older adults from Taiyuan, China, using a multi-stage random cluster sampling method. The data was collected with the general questionnaire for the elderly, with the Short Form Geriatric Depression Scale (GDS-15), and the Pittsburgh Sleep Quality Index (PSQI). The Bootstrap program and simple slope method were used to test the mediating effect of sleep quality and the moderating effect of empty nest status. RESULTS: The overall prevalence of depressive symptoms in the population was 33.4%. The mediating effect analysis showed that chronic diseases had a significant direct impact on depressive symptoms in the elderly (ß = 0.431, P < 0.001). Sleep quality as a mediation effect of 43.4% between chronic diseases and depressive symptoms was proven. The further moderating effect found that chronic diseases had a more significant impact on the sleep quality of the elderly who are in the empty nest status than those who are not (ß = -0.431, P < 0.05 ). LIMITATIONS: Given the cross-sectional study, the results cannot explain the causal relationships among the study variables. CONCLUSIONS: Chronic diseases had a major impact on the depressive symptoms of the elderly. Sleep quality mediated the relationship between chronic diseases and depressive symptoms, and the empty nest status moderated the first half of the path in the mediation model. Therefore, to reduce the incidence of the depressive symptoms of the elderly, sleep quality and empty nest status should be the primary concern.