Skip to main content
Download PDF
Download ePub

Association between functional disability and mental health among Chinese older adults: Examining the moderating effects of social participation and physical exercise

Archives of Public Health volume 82, Article number: 212 (2024) Cite this article

Abstract

Background

Functional disability significantly burdens healthcare services, negatively affecting older adults’ social interaction and quality of life. This study aims to identify the association between functional disability and mental health, and examine the moderating effects of social participation and physical exercise on the association.

Methods

The data were drawn from 2018 wave of Chinese Longitudinal Healthy Longevity Survey, and ordinary least squares regression model was exploited to explore the association between functional disability and mental health.

Results

Activity of daily living (ADL) disability negatively predicted mini-mental state examination (MMSE) score. Furthermore, social participation and physical exercise moderated the association between ADL disability and MMSE score.

Conclusion

The results highlight the importance of social participation and physical exercise for the older adults with ADL disability.

Peer Review reports

Text box 1. Contributions to the literature

• ADL disability negatively predicted MMSE score.

• Social participation moderated the association between ADL disability and MMSE score.

• Physical exercise moderated the association between ADL disability and MMSE score.

Background

In recent decades, the growth in the number of people over 65 years old in China has accelerated. By the end of 2022, China had more than 209 million people who aged 65 and above, accounting for 14.9% of the total population [1]. China is faced with an increased burden due to a growth in number of older adults, a decrease in working-age population, and slower economic growth. To cope with such challenge of aging, the Chinese government has adopted the strategy of active aging initially put forward by G-7 Summit in 1997. The active aging strategy regards the older adults as critical social resources, and encourages them to continuously participate in social, economic, cultural, and public affairs [2]. According to the 14th Five-year Planning on Development of Undertakings for the Older Adults and the Construction for the Pension System of China, it is essential to guide the older adults to establish the concept of active health and lifelong development, promote positive aging in the whole society, participate in family, community and social development, and make new contributions. The planning also highly encouraged people to actively accept the participation of the older adults in social development.

Functional disability, which refers to loss of self-care ability caused by weakness, disability, disease, dysgnosia, etc., is prevalent in the older adults due to decreased physical function [3, 4]. Functional disability significantly burdens healthcare services, negatively affecting the older adults’ social interaction and quality of life [5]. Furthermore, physical health is correlated with mental health [6], and functional disability causes emotional burdens for disabled people [7]. Specifically speaking, individuals with functional disabilities, who are usually considered as a vulnerable group, may experience a loss of confidence and even feel like a burden to their families. Caring for the older adults with functional disabilities is a daunting challenge, especially for a country with large populations. The Chinese government has introduced a long-term care insurance program to address the challenge of caring for the older adults with functional disabilities. The program aims to provide a sustainable and effective solution to ensure that these people receive the necessary care and support as they age. In addition, the program provides financial assistance for long-term care services to ease the burden on families and caregivers who may have difficulties providing sufficient care on their own. This effort is a noteworthy stride towards meeting the needs of China’s aging population and advancing social welfare.

Aside from physical disabilities, approximately 17.50% of Chinese people experience mental health disorders [8]. This issue has become increasingly worrisome, with many individuals experiencing mental health disorders. Mental health has been included in the United Nations (UN) Sustainable Development Goals (SDGs), which states that it is necessary to include mental health care in universal health coverage [9]. Furthermore, mental disorders have posed daunting challenges to the health system and led to emotional and financial burdens on the older adults. Besides, the older adults are prone to loneliness, anxiety, and depressive symptoms due to retirement, death of spouse, and immigration of sons or daughters [10].

It appears that there is a relationship of physical function and mental health. Previous studies have shown a strong connection of the physical and mental health of the older adults [11,12,13,14]. Some studies reveal that poor physical health may trigger mental illness in the older adults [15, 16]. Barry et al. found that disability was strongly related to the subsequent depression at the end of each 18-month interval [17]. A study demonstrated the interrelation of physical and mental health of the older adults over 21-year period, and the effect of mental health on subsequent physical health is weaker than that of physical health on subsequent mental health in later adulthood [18].

Some studies investigated the association between activity of daily living (ADL) disability and mental health. For instance, a study in Japan suggests that functional ADL was significantly correlated with psychological health [19]. Livneh and Antonak found that functional disability led to various psychological reactions, such as shock, anxiety, and anger [20]. Similarly, the study of Meeks and Walker indicates that competence in ADL was significantly correlated with negative symptoms [21]. Additionally, HacihasanoÄŸlu et al. discovered that being entirely dependent while performing ADL was correlated with increased loneliness [22]. Furthermore, Ding and Wang found that ADL disability had a negative effect on life satisfaction [23]. A study which was conducted by Jilili & Liu found that depression and anxiety are significantly higher for the older adults with IADL disability [24].

Social participation and physical exercise are important factors affecting mental health. Multiple studies have assessed the association of social participation and mental health. For instance, Haslam et al. found that social participation had a positive effect on cognitive health [25]. A study which was performed in Korea also confirmed the significantly positive effect of social participation on cognitive function [26]. Liu et al. further found that life satisfaction played a mediating effect on the correlation of social participation and cognitive decline [27]. The study of Guo et al. reveals that social participation plays a protective effect against depression [28]. Lu et al. found that social participation was significantly correlated with happiness [29]. Xu and Yang found that social participation significantly improved the mental health in China [30]. In addition, some studies have investigated the correlation between physical exercise and mental health. Farmer et al. discovered that physical activity could significantly reduce depressive symptoms [31]. Cunningham et al. found that physical activity is closely correlated with mental health in the older adults [32]. The study of Steptoe and Butler indicates that participation in sports significantly improved emotional well-being [33].

Previous studies have suggested that individuals with functional disabilities tend to experience negative consequences in terms of mental health. In addition, some researches have also shown that social participation and physical exercise have positive effects on mental health. Given this information, we propose that social participation and physical exercise may mitigate the negative impact of functional disability on mental health. Existing research has focused on the negative effect of functional disability, but has not taken the moderating effects of social participation and physical exercise on the correlation of functional disability and mental health into account. This study aims to identify the association between functional disability and mental health, and examine the moderating effects of social participation and physical exercise on the association. By analyzing the impact mechanism of functional disability on mental health, this study will provide references for practical policy interventions which aims at improving mental health of the older adults and addressing the challenges of population aging.

Methods

Data source

The data were drawn from 2018 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS), which is an ongoing and high-quality survey [34]. In addition, the CLHLS uses multistage random sampling method, covers 23 provinces in China, and can be called a nationally representative survey. 3,745 older adults are included in this study.

Variables

Dependent variable

Inspired by the finding that cognitive function can objectively reflect mental health [35], we exploit it to measure the dependent variable (mental health). In this study, Chinese version of mini-mental state examination (MMSE) scale is exploited to assess cognitive function. Actually, the scale has been widely used to measure cognitive function [36,37,38,39,40,41]. In addition, some studies reveal that the scale showed high reliability and validity [36, 39].

Independent variable

Functional disability is the key independent variable. Given the fact that ADL scale has been proved to be an effective tool to capture basic physical functions and measure functional disability [42, 43], we used it to measure functional disability. ADL scale was firstly put forward by Katz et al. [44], which reflects basic physical function, such as eating, dressing, indoor mobility, bathing, using the toilet, and continence. We categorize respondents as suffering from ADL disability (coded as 1) if they had difficulty in performing any of the activities.

Covariates

Based on existing studies [45, 46], we selected some covariates that are associated with mental health. The covariates include age, gender, marital status, residency area, years of schooling, household income, health insurance, and number of children.

Moderators

The current study aims to investigate the moderating effects of social participation and physical exercise on the association of functional disability and mental health. Therefore, we select these two variables as moderators. Social participation refers to engaging in activities such as paid work, volunteering, or mutual-help activities that involve interaction with others [47, 48]. Based on Kelly et al. [49], social participation is also called social activities. Following previous studies [50, 51], social participation is measured by a dummy variable which reflects whether the older adult participates in social activities (coded as 1) or not (coded as 0) at present. In addition, physical exercise refers to the physical activities related to improving individual health outcomes, which are usually stable and difficult to change after formation. Following existing research [52,53,54], physical exercise is also a dummy variable reflecting whether the older adult participates in physical exercise (coded as 1) or not (coded as 0) at present.

Model specification

In this study, ordinary least squares regression model was exploited to explore the association of functional disability and mental health. The basic econometric model can be specified as follows:

$$\:{MH}_{i}={\alpha\:}_{0}+{\alpha\:}_{1}{FD}_{i}+\sum\:_{j=1}^{n}{\alpha\:}_{j}{X}_{ji}+{\epsilon\:}_{i}$$
(1)

where MHi is mental health for older adult i, FDi denotes the functional disability, Xji denotes the covariates, α0 denotes the intercept term, α1 indicates the coefficient of functional disability, αj indicates the coefficient of the j th covariate, and εi denotes the error term.

To elaborate on how the association between functional disability and mental health changes with social participation, we add the interaction term of functional disability and social participation, and the variable social participation to Eq. (1).

$$\:{MH}_{i}={\beta\:}_{0}+{\beta\:}_{1}{FD}_{i}+{\beta\:}_{2}{FD}_{i}*{SP}_{i}+{\beta\:}_{3}{SP}_{i}+\sum\:_{j=1}^{n}{\beta\:}_{j}{X}_{ji}+{\epsilon\:}_{i}$$
(2)

where SPi is the social participation of older adult i, β0 denotes the intercept term, β1, β2, and β3 denote the coefficients to be estimated, and βj indicates the coefficient of the j th covariate.

Similarly, in order to test the moderating effect of physical exercise, we specify the following econometric model:

$$\:{MH}_{i}={\gamma\:}_{0}+{\gamma\:}_{1}{FD}_{i}+{\gamma\:}_{2}{FD}_{i}*{PE}_{i}+{\gamma\:}_{3}{PE}_{i}+\sum\:_{j=1}^{n}{\gamma\:}_{j}{X}_{ji}+{\epsilon\:}_{i}$$
(3)

where PEi is the physical exercise of older adult i, γ0 indicates the intercept term, γ1, γ2, and γ3 indicate the coefficients to be estimated, and γj denotes the coefficient of the j th covariate.

Results

Descriptive statistics

Table 1 presents characteristics of the study population. The mean value of MMSE score is 28.14. Approximately 9% of the older adults suffer from ADL disability. About 18% of them participate in social activities, and more than 40% of them participate in physical exercise.

Table 1 Characteristics of the study population of the 2018 wave of Chinese Longitudinal Healthy Longevity Survey
Full size table

Regression results

Table 2 displays regression results of the association between ADL disability and MMSE score. Models 1–3 reveal that ADL disability is correlated with a reduced MMSE score (p < 0.01). This means that the older adults with ADL disability have a lower MMSE score than those without ADL disability.

Table 2 Regression results of the association between activity of daily living disability and mini-mental state examination score among the older adults of the 2018 wave of Chinese Longitudinal Healthy Longevity Survey
Full size table

Moderating effects

Table 3 shows how the association of ADL disability and MMSE score changes with social participation. The estimate of the interaction term of ADL disability and social participation is statistically significant and positive, which indicates that social participation relieves the negative effect of ADL disability on MMSE score. Additionally, Fig. 1 also illustrates that social participation alleviates the negative influence of ADL disability on MMSE score.

Table 3 Moderating effect of social participation on the association between activity of daily living disability and mini-mental state examination score among the older adults of the 2018 wave of Chinese Longitudinal Healthy Longevity Survey
Full size table
Fig. 1
figure 1

Moderating effect of social participation on the association between activity of daily living disability and mini-mental state examination score among the older adults of the 2018 wave of Chinese Longitudinal Healthy Longevity Survey. MMSE indicates mini-mental state examination; ADL indicates activity of daily living

Full size image

As can be seen from Table 4, interaction term of ADL disability and physical exercise is significantly related to a higher MMSE score (coefficient = 1.1134, p < 0.05), which reveals that physical exercise moderates the association of ADL disability and MMSE score. That is to say that physical exercise attenuates the effect of ADL disability on MMSE score, which is in line with Fig. 2.

Table 4 Moderating effect of physical exercise on the association between activity of daily living disability and mini-mental state examination score among the older adults of the 2018 wave of Chinese Longitudinal Healthy Longevity Survey
Full size table
Fig. 2
figure 2

Moderating effect of physical exercise on the association between activity of daily living disability and mini-mental state examination score among the older adults of the 2018 wave of Chinese Longitudinal Healthy Longevity Survey. MMSE indicates mini-mental state examination; ADL indicates activity of daily living

Full size image

Discussion

Using the 2018 wave of CLHLS dataset, the present study investigates the relationship of functional disability and mental health, and explores how the relationship changes with social participation and physical exercise. The findings add new empirical evidence to the correlation of functional disability and mental health from Chinese perspective. Our findings indicate that ADL disability is significantly and negatively correlated with MMSE score. In other words, ADL disability significantly impairs the cognitive function. Rajan et al. also found that ADL disability was significantly correlated with a faster rate of decline in cognitive function [55]. In addition, some studies reveal that the older adults’ ability to perform ADL may be affected by changes in cognitive function, such as memory and problem-solving [56, 57]. The findings provide essential guidance on developing necessary interventions that can support healthy aging and help to ensure that the older adults can receive the care and support that they need. Eventually, we can work together to formulate more effective and impactful solutions that will benefit our communities and society as a whole.

More importantly, both social participation and physical exercise alleviate the negative effect of ADL disability on MMSE score. The results highlight the significance of social participation and physical exercise for the older adults who are faced with challenges in their daily lives due to functional disability. This is especially essential as it can significantly improve their mental health. Consequently, it is imperative for the Chinese government to take proactive steps in encouraging and promoting social participation and physical exercise to facilitate healthy aging.

The present study provides several policy implications. First, it is important for the Chinese government to attach importance to mental health of the older adults with ADL disability. Specifically speaking, the Chinese government needs to increase financial input and integrate resources from the community, primary healthcare institutions, psychiatric hospitals, and centers for disease control to establish professional psychological counseling institutions, so that social workers and volunteers with professional psychological knowledge can provide psychological care services. In China, there are initiatives in place to improve health through basic public health services. One approach involves the creation and maintenance of health records for the older adults. This allows the government to obtain the older adults’ related health information, which can be helpful when implementing targeted prevention measures. Evaluating the effectiveness of these measures can also be done through these records. Another approach involves health management for the older adults, which helps researchers understand their health patterns and needs. In terms of preventive medicine, managing health records for the older adults can be a form of primary prevention. Through the creation of these records, the mental health of the older adults can be assessed, particularly for those who may be at risk due to factors such as restricted mobility or strained family relationships. This information can then serve as a basis for professional institutions to provide psychological intervention. Psychological counseling institutions are considered as a form of secondary prevention. Their goal is to help individuals achieve remission of their mental health problems and reduction in recurrence remission. Tertiary prevention is also important, which involves taking care of the older adults and meeting their reasonable needs. It’s also crucial to consider how the psychological and social environment can affect disease prognosis and recurrence. By improving the living conditions and solving the difficulties in their daily lives, we can prevent them from potential damage to their mental health when they return to their original environment. Furthermore, the Chinese government also needs to improve long-term care insurance for the older adults to meet their basic care needs. In China, the household population structure is characterized by a couple supporting four elderly individuals and one child. As individuals age, the likelihood of experiencing health issues increases. When the older adults experience muscle function impairment, which place huge economic and care pressures on their families, they may require long-term care. However, the older adults hope to avoid burdening their children and enjoy their golden years with dignity. It is important for communities and local organizations to work together in providing volunteer services for the older adults with ADL disabilities. This will help reduce the burden of care of family members. In addition, a warm and loving family environment is vital to let the older adults feel encouraged with love and patience.

Second, the Chinese government needs to develop some diversified education programs for the older adults, including teaching medication knowledge, rehabilitation knowledge, and some social participation skills, to enhance their medical compliance, rehabilitation confidence, and social participation ability. Then, the government can build an information platform concerning social activities for the older adults with ADL disability, and guide them to take an active part in social activities. Furthermore, it is of great importance to create a friendly social environment, so that the willingness of the older adults to participate in social activities as volunteers can be translated into action. In addition, the community needs to provide the older adults with opportunities to participate in social activities and expand their social networks by providing opportunities to communicate and connect with others. It is worth noting that government should pay attention to the older adults’ feelings. As people age, their social connections significantly weaken. In this case, it is important for the government to examine the specific needs of the older adults, not just focusing on rebuilding their social relationships. The government should use its information search capabilities to find activities that fit the interests of the older adults. The older adults have the potential to develop new social connections independently while engaging in various activities. The older adults become a limited resource when it comes to implementing these activities. It’s important to avoid overwhelming them with too many activities that may cause tension or conflict.

Third, because of the important influence of physical exercise on the older adults with ADL disability, it is extremely essential for the Chinese government to provide more government-sponsored fitness programs, and collaborate with private organizations to provide more physical exercise facilities. The construction of sports venues should be promoted for the older adults to make it more convenient for them to take exercises. It is important to highlight the needs and characteristics of fitness for the older adults with ADL disability in fitness facilities built in parks and various sports venues. The community should offer some places for fitness and organize some sports and fitness programs. Assistive devices for rehabilitation are crucial in aiding the older adults with disabilities to exercise. It is common for the older adults to experience difficulties while walking. However, walking aid equipment, such as crutches and canes, can improve stability, minimize the risk of falling, and motivate them to engage in indoor and outdoor walking exercises. Compared with crutches, bicycles designed for rehabilitation offer a form of aerobic exercise that is gentle on the body and especially useful for the older adults with weakened muscles. The use of appropriate assistive equipment and exercise routines can improve physical health of the older adults with ADL disability, boost their quality of life, and ultimately enhance their mental health.

This is the first study to examine the moderating effects of social participation and physical exercise on the correlation of ADL disability and mental health in China, which is important to understand the underlying impact mechanism. In addition, this study provides a promising policy intervention strategy for the Chinese government. However, the present study has two limitations. On the one hand, due to the unavailability of data, the measurement of duration of functional disability is not included this study, which probably affects the estimation of this study. Future studies should consider using this variable. On the other hand, due to the cross-sectional design, we cannot fix problems concerning the time-invariant omitted variables and a causal relationship between ADL disability and mental health can not be identified. Future studies are encouraged to explore the causal relationship between ADL disability and mental health.

Conclusion

In conclusion, there is a correlation between functional disability and mental health. Furthermore, social participation and physical exercise relieve the negative effect of functional disability on mental health. It is necessary to guide the older adults with functional disability to participate in social activities and physical exercise. It is worth noting that both the government and society should ensure that the older adults have opportunities to participate in social activities and physical exercise, especially for those with functional disability. Furthermore, assistive devices for rehabilitation can be provided to them. In addition, it is necessary to address the psychological barriers that prevent the older adults with functional disabilities from social participation. To achieve this, collaboration between the government, society, and individuals in creating a supportive environment for the older adults’ mental health is needed.

Data availability

The data used in this study are drawn from the Chinese Longitudinal Healthy Longevity Survey.

References

  1. Ministry of Civil Affairs of the People’s Republic of China, Office of China National Working Committee on Ageing. Ageing in 2022. Communique on Development of National Undertaking for; 2023.

  2. Feng Y, Wu B. Aging and Global Health. Beijing: People’s Medical Publishing House; 2018.

    Google Scholar 

  3. Peng X, Song L, Mao Z. A study on issues linked to China’s disabled elderly–with focus on the disability assessment tools in China’s long-term care service. J Xinjiang Normal Univ (Edition Philos Social Sciences). 2018;39(5):102–18.

    Google Scholar 

  4. ColónEmeric CS, Whitson HE, Pavon J, et al. Functional decline in older adults. Am Family Phys. 2013;88(6):388–94.

    Google Scholar 

  5. Fried TR, Bradley EH, Williams CS, et al. Functional disability and Health Care expenditures for older persons. Arch Intern Med. 2001;161(21):2602–7.

    Article  CAS  PubMed  Google Scholar 

  6. Ohrnberger J, Fichera E, Sutton M. The relationship between physical and mental health: a mediation analysis. Soc Sci Med. 2017;195:42–9.

    Article  PubMed  Google Scholar 

  7. Li J, Liu B. The Effect of Health changes on Self-reported quality of life of the Elderly in China: fixed effects Model Analysis based on CLHLS Data. Popul Econ. 2015;36(6):1–11.

    Google Scholar 

  8. Phillips MR, Zhang J, Shi Q, et al. Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001–05: an epidemiological survey. Lancet. 2009;373(9680):2041–53.

    Article  PubMed  Google Scholar 

  9. UN General Assembly. Resolution A/RES/70/1—Transforming our world: the 2030 agenda for Sustainable Development. New York: United Nations; 2015.

    Google Scholar 

  10. Li Y, Ma H. Health Education and Health Promotion. Beijing: People’s Medical Publishing House; 2020.

    Google Scholar 

  11. Barry LC, Allore HG, Bruce ML, et al. Longitudinal association between depressive symptoms and disability burden among older persons. Journals Gerontol Ser A: Biomedical Sci Med Sci. 2009;64(12):1325–32.

    Article  Google Scholar 

  12. Verhaak PFM, Dekker JH, De Waal MWM, et al. Depression, disability and somatic diseases among elderly. J Affect Disord. 2014;167:187–91.

    Article  CAS  PubMed  Google Scholar 

  13. Brewster GS, Peterson L, Roker R, et al. Depressive symptoms, cognition, and everyday function among community-residing older adults. J Aging Health. 2017;29(3):367–88.

    Article  PubMed  Google Scholar 

  14. González-Blanch C, Hernández-de-Hita F, Munoz-Navarro R, et al. Domain-specific associations between disability and depression, anxiety, and somatization in primary care patients. Psychiatry Res. 2018;269:596–601.

    Article  PubMed  Google Scholar 

  15. Geerlings SW, Beekman ATF, Deeg DJH, et al. Physical health and the onset and persistence of depression in older adults: an eight-wave prospective community-based study. Psychol Med. 2000;30(2):369–80.

    Article  CAS  PubMed  Google Scholar 

  16. Weinberger MI, Raue PJ, Meyers BS, et al. Predictors of new onset depression in medically ill, disabled older adults at 1 year follow-up. Am J Geriatric Psychiatry. 2009;17(9):802–9.

    Article  Google Scholar 

  17. Barry LC, Soulos PR, Murphy TE, et al. Association between indicators of disability burden and subsequent depression among older persons. Journals Gerontol Ser A: Biomedical Sci Med Sci. 2013;68(3):286–92.

    Article  Google Scholar 

  18. Luo MS, Chui EWT, Li LW. The longitudinal associations between physical health and mental health among older adults. Aging Ment Health. 2020;24(12):1990–8.

    Article  PubMed  Google Scholar 

  19. Yasunaga A, Tokunaga M. The relationships among Exercise Behavior, Functional ADL, and Psychological Health in the Elderly. J Physiol Anthropol Appl Hum Sci. 2001;20(6):339–43.

    Article  CAS  Google Scholar 

  20. Livneh H, Antonak RF. Psychosocial adaptation to chronic illness and disability: a primer for counselors. J Couns Dev. 2005;83(1):12–20.

    Article  Google Scholar 

  21. Meeks S, Walker J. Blunted affect, blunted lives? Negative symptoms, ADL functioning, and mental health among older adults. Int J Geriatr Psychiatry. 1990;5(4):233–8.

    Article  Google Scholar 

  22. Hacihasanoglu R, Yildirim A, Karakurt P, et al. Loneliness in elderly individuals, level of dependence in activities of daily living (ADL) and influential factors. Arch Gerontol Geriatr. 2012;54(1):61–6.

    Article  PubMed  Google Scholar 

  23. Ding B, Wang Y. From body to mind: Chinese Elderly people’s disability status and happiness. Popul Dev. 2017;23(5):82–90.

    Google Scholar 

  24. Jilili M, Liu L. Examining the impact of functional disability and cognitive impairment on mental health of Chinese elderly. Soc Work Health Care. 2022;61(5):338–52.

    Article  PubMed  Google Scholar 

  25. Haslam C, Cruwys T, Haslam SA. The we’s have it: evidence for the distinctive benefits of group engagement in enhancing cognitive health in aging. Soc Sci Med. 2014;120:57–66.

    Article  PubMed  Google Scholar 

  26. Lee Y, Yeung WJJ. Gender matters: productive social engagement and the subsequent cognitive changes among older adults. Soc Sci Med. 2019;229:87–95.

    Article  PubMed  Google Scholar 

  27. Liu L, Cheng H, Peng X. The influence of Social Participation Model on Cognitive decline of the Elderly in China. Chin J Popul Sci. 2022;36(4):103–14.

    Google Scholar 

  28. Guo Q, Bai X, Feng N. Social participation and depressive symptoms among Chinese older adults: a study on rural-urban differences. J Affect Disord. 2018;239:124–30.

    Article  PubMed  Google Scholar 

  29. Lu N, Spencer M, Sun Q, et al. Family social capital and life satisfaction among older adults living alone in urban China: the moderating role of functional health. Aging Ment Health. 2021;25(4):695–702.

    Article  PubMed  Google Scholar 

  30. Xu M, Yang W. Depressive symptoms among older empty nesters in China: the moderating effects of social contact and contact with one’s children. Aging Ment Health. 2023;27(1):54–69.

    Article  PubMed  Google Scholar 

  31. Farmer ME, Locke BZ, Mosciki EK, et al. Physical activity and depressive symptoms: the NHANES I epidemiologic follow-up study. Am J Epidemiol. 1988;128:1340–51.

    Article  CAS  PubMed  Google Scholar 

  32. Cunningham C, O’Sullivan R, Caserotti P, et al. Consequences of physical inactivity in older adults: a systematic review of reviews and meta-analyses. Scand J Med Sci Sports. 2020;30(5):816–27.

    Article  PubMed  Google Scholar 

  33. Steptoe A, Butler N. Sports participation and emotional well being in adolescents. Lancet. 1996;347:1789–92.

    Article  CAS  PubMed  Google Scholar 

  34. Zeng Y, James WV, Xiao Z, et al. Sociodemographic and Health profiles of the Oldest Old in China. Popul Dev Rev. 2002;28(2):251–73.

    Article  Google Scholar 

  35. Zhai S, Wang J. The relations between social support and subjective wellbeing among elderly: a study based on the multiple mediation effects of mental health factors. Northwest Popul J. 2018;39(4):43–50.

    Google Scholar 

  36. Zhang Z, Gu D, Hayward MD. Early life influences on cognitive impairment among oldest old Chinese. Journals Gerontol Ser B: Psychol Sci Social Sci. 2008;63(1):S25–33.

    Article  Google Scholar 

  37. Shen K, Zeng Y. The Association between Resilience and Survival among Chinese Elderly. Demographic Res. 2010;23(5):105–16.

    Article  Google Scholar 

  38. Cheng L, Liu H, Zhang Y, et al. The health implications of social pensions: evidence from China’s new rural pension scheme. J Comp Econ. 2018;46(1):53–77.

    Article  Google Scholar 

  39. Gao M, Li Y, Zhang S, et al. Does an empty nest affect elders’ health? Empirical evidence from China. Int J Environ Res Public Health. 2017;14(5):463.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Lai W. Pesticide Use and Health outcomes: evidence from Agricultural Water Pollution in China. J Environ Econ Manag. 2017;86:93–120.

    Article  Google Scholar 

  41. Zhang Y, Gu Y, Zhang Y, et al. Effect of sociodemographic and physical activity on cognitive function in older adults: a nationwide cross-sectional survey. Int J Geriatr Psychiatry. 2019;34:243–8.

    Article  PubMed  Google Scholar 

  42. Gu D, Zeng Y. Sociodemographic effects on the onset and recovery of ADL disability among Chinese oldest-old. Demographic Res. 2004;11(1):1–42.

    Article  CAS  Google Scholar 

  43. Lima-Costa MF, Mambrini JVM, Peixoto SV, et al. Socioeconomic inequalities in activities of daily living limitations and in the provision of informal and formal care for noninstitutionalized older brazilians: National Health Survey, 2013. Int J Equity Health. 2016;15(1):1–8.

    Article  Google Scholar 

  44. Katz S, Ford AB, Moskowitz RW, et al. Studies of illness in the aged: the Index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963;185(12):914–9.

    Article  CAS  PubMed  Google Scholar 

  45. Sun J, Lyu S. Social participation and urban-rural disparity in mental health among older adults in China. J Affect Disord. 2020;274:399–404.

    Article  PubMed  Google Scholar 

  46. Roberts S, Arseneault L, Barratt B, et al. Exploration of NO2 and PM2.5 air pollution and mental health problems using high-resolution data in London-based children from a UK longitudinal cohort study. Psychiatry Res. 2019;272:8–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Glass TA, De Leon CF, Bassuk SS, et al. Social engagement and depressive symptoms in late life: longitudinal findings. J Aging Health. 2006;18(4):604–28.

    Article  PubMed  Google Scholar 

  48. Hsu HC. Does social participation by the elderly reduce mortality and cognitive impairment? Aging Ment Health. 2007;11(6):699–707.

    Article  CAS  PubMed  Google Scholar 

  49. Kelly ME, Duff H, Kelly S, et al. The impact of social activities, social networks, social support and social relationships on the cognitive functioning of healthy older adults: a systematic review. Syst Reviews. 2017;6(1):1–18.

    Article  CAS  Google Scholar 

  50. Wu J, Li J. The impact of social participation on older people’s death risk: an analysis from CLHLS. China Popul Dev Stud. 2018;2:173–85.

    Article  Google Scholar 

  51. Ma X, Piao X, Oshio T. Impact of social participation on health among middle-aged and elderly adults: evidence from longitudinal survey data in China. BMC Public Health. 2020;20(1):1–8.

    Google Scholar 

  52. Zhou Z, Fu J, Hong YA, et al. Association between exercise and the risk of dementia: results from a nationwide longitudinal study in China. BMJ Open. 2017;7(12):e017497.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Gao M, Sa Z, Li Y, et al. Does social participation reduce the risk of functional disability among older adults in China? A survival analysis using the 2005–2011 waves of the CLHLS data. BMC Geriatr. 2018;18:1–13.

    Article  Google Scholar 

  54. Wei K, Liu Y, Yang J, et al. Living arrangement modifies the associations of loneliness with adverse health outcomes in older adults: evidence from the CLHLS. BMC Geriatr. 2022;22(1):1–11.

    Article  CAS  Google Scholar 

  55. Rajan K, Hebert LE, Scherr PA et al. Disability in basic and instrumental activities of daily living is associated with faster rate of decline in cognitive function of older adults. Journals of Gerontology - Series A Biological sciences and Medical sciences. 2013; 68(5):624–30.

  56. Gallo JJ, Rebok GW, Tennsted S, et al. Linking depressive symptoms and functional disability in late life. Aging Ment Health. 2003;7(6):469–80.

    Article  CAS  PubMed  Google Scholar 

  57. Yen YC, Rebok GW, Gallo JJ, et al. Depressive symptoms impair everyday problem-solving ability through cognitive abilities in late life. Am J Geriatric Psychiatry. 2011;19(2):142–50.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to acknowledge the Chinese Longitudinal Healthy Longevity Survey for providing data.

Funding

This study was supported by Humanities and Social Science Youth Fund of Ministry of Education of China (23YJC630153), China Postdoctoral Science Foundation (2023M731718), Project of Jin Shanbao Institute for Agriculture & Rural Development of Nanjing Agricultural University (YZKKT2023008), Scientific Research Planning Project of Colleges and Universities in Anhui Province (2022AH051066), and Project under Guangxi Higher Education Institution Thousand Young Talents Cultivation Program in Humanities and Social Sciences: Assessing Long-Term Care Insurance Nursing Needs in Nanning of Guangxi (2022QGRW017).

Author information

Authors and Affiliations

  1. College of Public Administration, Nanjing Agricultural University, Nanjing, China

    Jian Sun & Yujiang Liu

  2. China Resources & Environment and Development Academy, Nanjing Agricultural University, Nanjing, China

    Jian Sun

  3. Jin Shanbao Institute for Agriculture & Rural Development, Nanjing Agricultural University, Nanjing, China

    Jian Sun

  4. School of Mathematics and Finance, Chuzhou University, Chuzhou, China

    Haiyong Zhang

  5. Center for Translational Regenerative Medicine, Guangxi Medical University, Nanning, China

    Xinxin Mo

  6. Department of Social and Ecological Civilization, Party School of Anhui Provincial Committee (Anhui Academy of Governance), Hefei, China

    Lin Pan

  7. School of Information and Management, Guangxi Medical University, Nanning, China

    Hongye Luo

Authors
  1. Jian Sun
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Haiyong Zhang
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Xinxin Mo
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Yujiang Liu
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Lin Pan
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Hongye Luo
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

HL designed the study, JS analyzed the data and wrote the paper, HZ, XM, YL, and LP revised the paper. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hongye Luo.

Ethics declarations

Ethical approvaland and consent to participate

The Chinese Longitudinal Healthy Longevity Survey has got the ethical approval from research ethics committees of Peking University and informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sun, J., Zhang, H., Mo, X. et al. Association between functional disability and mental health among Chinese older adults: Examining the moderating effects of social participation and physical exercise. Arch Public Health 82, 212 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13690-024-01431-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13690-024-01431-0

Keywords

Archives of Public Health

ISSN: 2049-3258