Association between Activities of Daily Living and Depression Symptoms among Older Adults in China: A Nationally Representative Cross-Sectional Survey

Background: Depressive symptoms are a serious public health problem that are associated with BADL and IADL disabilities in Chinese adults.Objective: The limitation of activities of daily living (ADL) affects the mental health of older adults. We distinguished activities of daily living into basic activities of daily living (BADL) and instrumental activities of daily living (IADL) to explore the relationship between these two limitations and depressive symptoms among older Chinese adults using nationally representative cross-sectional data. 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.Methods: The 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 Center 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 were associated with mental health status. A binary logistic regression model was used to evaluate this association further after controlling for confounding factors.Results: Overall, 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 <0.001), were literate (P <.001), lived in a rural area (P <.001), had a retirement pension (P <.001), had 3 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.Conclusions: The 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. Older adults should be encouraged to participate in moderate physical and social activities to prevent physical dysfunction. The government and social work organisations should pay attention to the mental health of older adults in rural areas.