Activity Limitations and Depressive Symptoms Among Older Couples: The Moderating Role of Spousal Care

Association between the hearing aid and mental health outcomes in people with hearing impairment: A case-control study among 28 European countries

BACKGROUND

Hearing loss affects over 1.5 billion individuals globally, with significant implications for mental health. This study investigates the association between hearing aid use and mental health outcomes, by particularly focusing on depression and unmet mental health needs (UMHN), across a diverse international sample.

METHODS

Utilizing data from the third wave of the European Health Interview Survey (EHIS), this study involved 17,660 participants with hearing impairment from 28 countries. The study examined the association between hearing aid use and mental health outcomes, including the likelihood of moderate and severe depression and UMHN due to lack of contact with general practitioners (GPs) and mental health specialists. Logistic regression models, adjusted for socio-demographic characteristics, health risk behaviours, and other relevant variables, were employed. Inverse probability weights were used to mitigate potential selection bias.

RESULTS

Hearing aid usage was associated with significantly lower likelihoods of moderate depression (Odds Ratio [OR] = 0.58, 95%CI = [0.54, 0.63]) and severe depression (OR = 0.61, 95%CI = [0.55, 0.69]), compared to non-usage. Hearing aid usage was also associated with reduced UMHN due to lack of GP contact for moderate (OR = 0.82, 95%CI = [0.75, 0.89]) and severe depression (OR = 0.75, 95%CI = [0.59, 0.95]). The depression risk reductions were greater among females and higher-educated subgroups but lower in individuals aged ≥65 years. Income level and rurality also impacted UMHN due to the lack of GP contact. No associations were found between hearing aids and UMHN due to the lack of mental health specialist contact.

CONCLUSIONS

Hearing aid adoption showed protective associations against mood disorders and lowered unmet primary mental healthcare needs. Tailoring intervention strategies to vulnerable sociodemographic profiles could optimize mental health benefits among those with hearing loss. Integrating hearing health services within mental healthcare delivery frameworks is vital amidst the rising global burden.

Analysis of the effect of BMI on depression and anxiety among older adults in China: the mediating role of ADL and IADL

Background

Anxiety and depression are serious psychological and public health issues among the older adults. Currently, there is a lack of understanding of the relationship between Body Mass Index (BMI) and anxiety or depression symptoms in the older adult population in China. Therefore, the purpose of this study is to investigate the impact of BMI on anxiety and depression through correlation analysis in different subgroups and to examine the potential chain mediating effects of Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) between BMI and symptoms of anxiety and depression.

Methods

From the CLHLS database conducted in 2017-2018, data regarding height, weight, anxiety symptoms, depression symptoms, as well as demographic, socioeconomic, behavioral, and health-related characteristics were collected. Multivariate logistic regression analysis was used to explore the impact of BMI on anxiety and depression symptoms. Finally, the SPSS macro process was utilized to test the multiple mediating effects of ADL and IADL between BMI and anxiety or depression symptoms.

Results

After screening, a final sample of 9,098 Chinese older adult individuals aged 65 and above was selected. Among them, 1,074 cases (11.8%) exhibited anxiety symptoms, 1,458 cases (16.0%) exhibited depressive symptoms. Compared to normal BMI, the adjusted analysis showed that underweight in Chinese older adult individuals was significantly associated with anxiety (OR = 1.316, p = 0.004) and depression (OR = 1.232, p = 0.013). This relationship was found to be more significant in males, individuals aged 80 and above, unmarried individuals, and those residing in town. ADL and IADL played a chain-mediated role between BMI and anxiety symptoms in the older adult. BMI not only had a direct effect on anxiety symptoms in the older adult (effect = -0.0159; SE = 0.0066; 95%CI: LL = -0.0288, UL = -0.0031), but also influenced them indirectly through two pathways: the independent mediating role of IADL (effect = -0.0010; SE = 0.0005; 95%CI: LL = -0.0018, UL = -0.0003) and the chain-mediated role of ADL and IADL (effect = -0.0012; SE = 0.0004; 95%CI: LL = -0.0020, UL = -0.0006).

Conclusion

In the older adult individuals in China, underweight is associated with an increased risk of anxiety and depression symptoms. Improving the underweight condition of Chinese older adult individuals can reduce their ADL and IADL limitations, thereby benefiting their mental health.

Dyadic Appraisals of Family Decisions and Health Tasks in Midlife-Older Couples

Shared appraisals and collaboration within couples play important roles in optimizing health. Less is known about concordance regarding collaboration, factors associated with concordance, and implications for health. Data from 2,761 couples from the Health and Retirement Study (2014/2016 and 2016/2018 waves) were examined to determine within-couple concordance in completion of two tasks (family decisions and medical forms). The majority of couples were concordant regarding who makes family decisions (69.7%) and who completes medical forms (64.4%); 62% agreed they make family decisions collaboratively versus 25.5% completing medical forms collaboratively. Concordance was significantly associated with greater marital support and longer marital duration. Concordance was not significantly associated with depressive symptoms 2 years later, but the link between concordance in making major family decisions and self-rated health differed by age and gender. Future research at the intersection of concordance and collaboration may shed important light on how older couples navigate tasks and decisions.

Shielded by Education? The Buffering Role of Education in the Relationships Between Changes in Mental Health and Physical Functioning Through Time Among Older Europeans

This study investigated among older Europeans how physical function limitations lead to depressive symptoms and reductions in quality of life and well-being, and vice-versa. Further examined was how years of education moderate these relationships. These objectives were pursued using a sample of Europeans aged 50+ years (N = 46,492) within waves 5 (2013) and 6 (2015) of the Survey of Health, Ageing and Retirement in Europe. The analyses employed conditional change multilevel mixed-effects linear regressions. Mental health was found to affect physical function limitations, and vice-versa. More education significantly reduced only how earlier mental health problems lead to later physical function limitations, plausibly because of the former's higher controllability. Thus highlighted are education-linked psychosocial resources' protective effects.

Association of spouse's health status with the onset of depressive symptoms in partner: Evidence from the China Health and Retirement Longitudinal Study

BACKGROUND

This study aimed to evaluate the associations between the multidimensional health status of one spouse and the onset of depressive symptoms in partner, and whether the associations differed by gender and residence.

METHODS

We analyzed data from 2401 females and their husbands (scenario 1), and 2830 males and their wives (scenario 2) who participated in the 2011/2012 and 2015 waves of China Health and Retirement Longitudinal Study. Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale. Multidimensional health indicators included mobility disability, activities of daily living disability, frailty, global cognition, depressive symptoms, comorbidity, and self-reported health. Principal component analysis was used to construct a composite health indicator reflecting overall health status that was then categorized into three groups (poor, moderate, and excellent). Logistic regression models were performed.

RESULTS

We observed strong associations of spouse's health status with the onset of depressive symptoms in partner. For instance, females whose husbands had poor overall health status reported more depressive symptoms than those having husbands with excellent overall health after four years (OR: 1.75; 95 % CI: 1.35, 2.26). These associations were statistically significant in rural females and urban males, but surprisingly disappeared in rural males and urban females.

LIMITATIONS

No exact timing of depressive symptoms onset.

CONCLUSIONS

In Chinese middle-aged and older adults, spouse's health status is associated with depressive symptoms in partner and the associations vary by gender and residence. The findings underscore the importance of considering partner's health status to manage one spouse's mental health.

The impact of hearing loss on trajectories of depressive symptoms in married couples

Hearing loss is a prevalent chronic stressor among older adults and is associated with numerous adverse health outcomes. The life course principle of linked lives highlights that an individual's stressors can impact the health and well-being of others; however, there are limited large-scale studies examining hearing loss within marital dyads. Using 11 waves (1998-2018) of the Health and Retirement Study (n = 4881 couples), we estimate age-based mixed models to examine how 1) one's own hearing, 2) one's spouse's hearing, or 3) both spouses' hearing influence changes in depressive symptoms. For men, their wives' hearing loss, their own hearing loss, and both spouses having hearing loss are associated with increased depressive symptoms. For women, their own hearing loss and both spouses having hearing loss are associated with increased depressive symptoms, but their husbands' hearing loss is not. The connections between hearing loss and depressive symptoms within couples are a dynamic process that unfolds differently by gender over time.

Caregiving: a risk factor of poor health and depression among informal caregivers in India- A comparative analysis

BACKGROUND

In an ageing society, the provision of long-term care is the prime need. In Indian cultural setting, family members are the informal, albeit primary caregivers to the elderly. Caregiving demands intense emotional and financial involvement. While taking care of elderly persons' health and wellbeing, these family members, acting as informal caregivers, may themselves become vulnerable to poor health due to additional stress and burden. Using a nationally representative survey, the study tried to identify how health condition varies within caregivers and a comparative analysis of how in similar socio-economic background health condition varies between caregivers and non-caregivers.

METHOD

The data, used for the analysis, is taken from Longitudinal Ageing Study in India (LASI), Wave I. Both descriptive and multivariable regression analysis are done in different models along with interaction effect of caregiving to understand the difference in health status between caregiver and non-caregivers.

RESULTS

Nearly 29% and 11% of the informal caregivers, reported to have depressive symptoms and poor self-rated health (SRH), respectively. Almost half of the caregivers, who provide care for more than 40 h a week, are diagnosed to have depressive symptoms. They are also at higher risk of having depressive symptoms (AOR 1.59 CI 1.16-2.18) and poor SRH (AOR 1.73 CI 1.11-2.69) than those who invest less than 40 h in a week. In almost every socio-economic condition, caregivers are at a higher risk of having depression and poor health than non-caregivers. Caregivers, who are widowed, live in rural areas or are not satisfied with current living arrangement are more vulnerable to have depressive symptoms. On the other hand, caregivers of age 45-59 years, widowed, male and who live only with their children with spouse absent, have almost 2 times higher odds of poor SRH than non-caregivers.

CONCLUSION

Caregivers are more susceptible to depression and poor self-rated health compared to non-caregivers irrespective of their socio-economic characteristics, only the magnitude of vulnerability varies.

Driving Hazard Perception Tests: A Systematic Review

Objective

The present study was conducted to evaluate previous studies on hazard perception among road users.

Methods

A comprehensive search was conducted using electronic databases and search engines including Science Direct, PubMed, Scopus, Embase, Web of Science, Iranmedex, SID, Irandoc, and Google Scholar from January 2000 to September 2021. The search was performed using a combination of medical subject heading terms and keywords. Endnote software version 20.0 (Clarivate, Philadelphia, PA, USA) was used to organize the included articles. Thematic content analysis was used to analyze the findings. The entire review process was conducted by two authors, and unresolved challenges were discussed with other researchers.

Results

Findings of the study show that all of the tests could discriminate between inexperienced and experienced drivers. The use of dynamic hazard perception tests was more common than static tests, and in some cases, simulators were used. Moreover, the results indicated a weak correlation between the results of dynamic and static tests. Therefore, it could be claimed that both dynamic and static methods measured certain dimensions of hazard perception.

Conclusion

Regarding the importance of hazard perception, the findings of this study can provide further progress in designing hazard perception tests. The hazard perception tests can be sensitive to cultural or legal differences. It should also be noted that in developing tools for measuring drivers' hazard perception, different dimensions of hazard perception must be considered, so that the level of drivers' hazard perception can be reported accurately.

Longitudinal relationship between sensory impairments and depressive symptoms in older adults: The mediating role of functional limitation

BACKGROUND

The underlying mechanism between sensory impairments (SIs) and depressive symptoms among Chinese older adults is not well understood. This study aims to explore the mediating role of functional limitation on the longitudinal relationship between SIs and depressive symptoms among older adults in China.

METHODS

A total of 4130 older adults who participated in the 3-year follow-up China Health and Retirement Longitudinal Study (CHARLS) were included in the analysis. The hierarchical multiple linear regression model and nonparametric bootstrapping method were employed to explore the relationship between SIs and depressive symptoms, and the mediating role of functional limitation in this link.

RESULTS

The prevalence of self-reported hearing impairment (HI) only, vision impairment (VI) only, and dual sensory impairment (DSI) at baseline were 5.7%, 22.2%, and 58.6%, respectively. After adjusting for controlling variables, older adults with DSI had significantly higher levels of depressive symptoms compared with those without SIs at baseline (β = .07, p = .005). The magnitude of mediation effect from DSI to depressive symptoms via functional limitation was a*b = 0.060 (BCa 95% confidence interval: 0.031-0.094).

CONCLUSIONS

Functional limitation partially mediated the relationship between DSI and depressive symptoms among Chinese older adults. Interventions of DSI and functional limitation should be included in depressive symptoms prevention among older adults in China.

Association between physical limitations and depressive symptoms among Indian elderly: marital status as a moderator

BACKGROUND

Depression among the elderly is well-documented and associated with socio-economic factors, physical and mental health conditions. Few studies have focused on older adults' physical limitations and depressive symptoms. However, very little is known about marital status' role in such associations, especially in India. The present study examines the association between physical limitations and self-reported depressive symptoms and moderating role of marital status in such association separately for men and women.

METHODS

The present study used data from the Longitudinal Ageing Study in India (LASI) wave 1, 2017-2018, a nationally and state representative longitudinal large-scale survey of ageing and health. For the present research, a total sample of 20,806 older adults aged 60+ years was selected after excluding missing values. Along with descriptive statistics, binary logistic regression analysis and interaction effect of marital status were applied to examine the association between physical limitations (functional limitations and mobility difficulty) with the depressive symptoms separately for men and women.

RESULTS

About 58, 50, and 45% elderly reported having depressive symptoms and had difficulty in 2+ ADLs, 2+ IADLs, and 2+ mobility difficulties, respectively. By the marital status, the prevalence of depressive symptoms was higher among currently unmarried than currently married, irrespective of type and number of physical limitations. The unadjusted, marital and multivariate-adjusted association suggested that elderly with more than two ADLs, IADLs, and mobility difficulty had higher odds of depressive symptoms. The gender stratified interaction effect of marital status and physical limitations on depressive symptoms indicated that currently unmarried elderly, particularly unmarried older women with 2+ ADLs (OR = 2.85; CI 95% = 1.88-3.09), 2+ IADLs (OR = 2.01; CI 95% = 1.74-2.31) and 2+ mobility difficulty (OR = 2.20; CI 95% = 1.86-2.60) had higher odds of depressive symptoms. However, such association was only valid for unmarried men having mobility difficulty.

CONCLUSION

The study highlights that the elderly with physical limitations such as ADLs, IADLs, and mobility difficulty require attention and care. Although married elderly are less likely to have depressive symptoms even with all the mentioned physical limitations, unmarried women are more vulnerable to have depressive symptoms with physical limitations.

Spousal Concordance in the Development of Functional Limitations Among Married Adults in China

IMPORTANCE

Functional limitation is increasingly common as people age and is often associated with negative consequences. Evidence of the dynamics of functional limitation within couples in China is still inadequate.

OBJECTIVES

To examine whether functional limitation was associated within middle-aged and older couples and to explore sex differences in spousal associations.

DESIGN, SETTING, AND PARTICIPANTS

In this nationwide, population-based cohort study performed from January 1, 2011, to December 31, 2018, participants were selected using multistage probability sampling, and 5207 community-dwelling couples (10 414 individuals) 45 years or older were included in the nationally representative China Health and Retirement Longitudinal Study. Data analysis was performed from January 1 to February 28, 2021.

EXPOSURES

The exposure variable was the presence of functional limitation in spouses. Functional limitation was measured by the activities of daily living (ADLs) and instrumental activities‎ of daily ‎living (IADLs) scales and was defined as having difficulty in independently performing at least 1 ADL or IADL item.

MAIN OUTCOMES AND MEASURES

The main outcome was functional limitation in index participants. Multivariable logistic regression with generalized estimating equations was used to estimate the reciprocal association of functional limitation within couples over time.

RESULTS

A total of 5207 married, different-sex couples (mean [SD] age, 59.1 [8.8] years for husbands and 57.0 [8.2] years for wives) were included in the study. For husbands, the number (percentage) of participants classified with baseline functional limitation was 1140 (21.9%), the number (percentage) with ADL limitation was 684 (13.1%), and the number (percentage) with IADL limitation was 834 (16.0%). For wives, the number (percentage) of participants classified with baseline functional limitation was 1502 (28.8%), the number (percentage) with ADL limitation was 887 (17.0%), and the number (percentage) with IADL limitation was 1183 (22.7%). Longitudinal results demonstrated an association in spouses developing functional limitation (adjusted odds ratio [OR], 2.55; 95% CI, 2.41-2.69; P < .001), ADL limitation (adjusted OR, 2.26; 95% CI, 2.11-2.41; P < .001), and IADL limitation (adjusted OR, 2.58; 95% CI, 2.43-2.73; P < .001). Subgroup analyses by sex revealed similar patterns of spousal health concordance in terms of all studied outcomes, indicating no sex specificity.

CONCLUSIONS AND RELEVANCE

This population-based cohort study suggests that among Chinese middle-aged and older couples there is significant concordance in the development of functional limitation. This study of spousal functional ability from a dyadic perspective may help in the understanding of health risks within a wider familial context and offers novel insights for prioritizing policy focus from individual centered to couple based.

Take a sad song and make it better: Spousal activity limitations, caregiving, and depressive symptoms among couples

OBJECTIVES

Framed around key concepts of the life course perspective, we examined the linkages between spousal activity limitations, caregiving transitions, and depression among married couples. The key study objectives were 1) to demonstrate how the caregiving-depression link widely reported in earlier research may have been over-stated, and 2) to investigate whether caregiving yields mental health benefits by weakening the link between spousal activity limitations and depressive symptoms.

METHODS

We used longitudinal data from the Health and Retirement Study (2004-2016) to examine a national sample of coupled individuals (6,475 couples; 57,844 person-wave observations). A series of longitudinal actor-partner interdependence models were used to estimate within-person associations between spousal activity limitations, caregiving transitions, and depressive symptoms among coupled individuals.

RESULTS

Findings demonstrated that spousal activity limitations function as a confounder for the association between caregiving transitions and depressive symptoms. Results further provided evidence that transitioning into a caregiving role in the context of spousal activity limitations alleviated symptoms of depression for the caregiver.

CONCLUSION

The findings provide an explanation for the extended longevity benefit reaped by caregivers increasingly reported in recent population studies. Implications for policy, practice, and future research are discussed.

Does financial inclusion predict a lower risk of loneliness in later life? Evidence from the AgeHeaPsyWel-HeaSeeB study 2016-2017

OBJECTIVE

For many older people, loneliness represents a common source of impaired quality of life particularly in the context of poor access to financial services. This article examines the association between financial inclusion and loneliness in older adults and explores the moderating effects of gender and physical activity in this association.

METHODS

One thousand two-hundred participants completed the Short Form Revised UCLA Loneliness Scale assessing loneliness during 2016-2017 Aging, Health, Psychological Well-being and Health-seeking Behavior (AgeHeaPsyWel-HeaSeeB) Study. Financial inclusion was assessed using an 8-item Financial Instrument Scale.

RESULTS

Multiple ordinary least squares (OLS) regressions showed that increases in financial inclusion were associated with decreases in loneliness in the total sample (β = -0.679, p < 0.001) and in women (β = -0.787, p < 0.001) but not in men (β = -0.594, p = 0.084). The negative effect of financial inclusion on loneliness was pronounced among those who engaged in physical activity (β = -0.646, p < 0.042).

CONCLUSIONS

Findings underscore the importance of financial inclusion for loneliness in later life particularly among older women and those who engage in physical activity. Encouraging and strengthening financial inclusion may crucially improve psychological health and emotional well-being among aging adults.

Financial inclusion and physical health functioning among aging adults in the sub-Saharan African context: Exploring social networks and gender roles

BACKGROUND

It remains poorly understood how financial inclusion influences physical health functioning in later life in sub-Saharan African context and whether the association differs by gender and social relationships. We aim 1) to examine the associations of financial inclusion with functional impairment during older age in Ghana; and 2) to evaluate whether gender and social networks modify this association.

METHODS

The cross-sectional analyses are based on a sample (N = 1,201) of study participants aged 50 years and over (M = 66.5 years, SD = 11.9, 63.3% female) deriving from the 2016-2017 AgeHeaPsyWel-HeaSeeB Study. Ordinary least squares (OLS) regression analyses with interactions were performed to estimate the link between financial inclusion and functional health and how the association is modified by gender and older age social networks.

RESULTS

The mean financial inclusion score was 1.66 (SD = 1.74) in women and 2.33 (SD = 1.82) in men whilst mean activities of daily living (ADL) score was 13.03 (SD = 4.99) and 14.85 (SD = 5.06) in women and men respectively. We found that financial inclusion was associated with decreases in ADL (total sample: β = -.548, p < .001; women: β = -.582, p < .001; men: β = -1.082 p < .001) and instrumental ADL (IADL) (total sample: β = -.359, p = .034; women: β = -.445, p = .026 but not in men). Social networks significantly moderated the association of financial inclusion with ADL such that the financially included who were embedded in a stronger constellation of social networks were 6% less likely to report ADL impairment compared to those with weaker social networks (β = -.062, p = .025).

CONCLUSIONS

The study provides empirical evidence for a better understanding of the association between financial inclusion and physical health functioning in the context of later life social networks. Interventions for functional health through financial inclusion in sub-Saharan Africa should include improving interpersonal and social networks for older adult and also through gender lenses.

Fear of falling is as important as multiple previous falls in terms of limiting daily activities: a longitudinal study

Background

Fear of falling and previous falls are both risk factors that affect daily activities of older adults. However, it remains unclear whether they independently limit daily activities accounting for each other.

Methods

We used the data from Round 1 (Year 1) to Round 5 (Year 5) of the National Health and Aging Trends Study. We included a total of 864 community-dwelling participants who provided data on previous falls, fear of falling and limited activities from Year 1 to Year 5 and had no limited daily activities at Year 1 in this study. Previous falls and fear of falling were ascertained by asking participants how many falls they had in the past year and whether they had worried about falling in the last month. Limited daily activities included any difficulties with mobility (e.g., going outside), self-care (e.g., eating), and household activities (e.g., laundering). Generalized estimation equation models were used to examine whether previous falls and fear of falling independently predicted development of limited daily activities adjusting covariates.

Results

Participants were mainly between 65 and 79 years old (83 %), male (57 %), and non-Hispanic White (79 %). Among participants who had multiple falls in Year 1, 19.1-31 %, 21.4-52.4 %, and 11.9-35.7 % developed limitations in mobility, self-care, and household activities during Year 2 to Year 5, respectively. Among those who had fear of falling in Year 1, 22.5-41.3 %, 30.0-55.0 %, and 18.8-36.3 % developed limitations in mobility, self-care, and household activities during Year 2 to Year 4, respectively. Fear of falling independently predicted limitations in mobility (Incidence rate ratio [IRR]: 1.79, 95 % CI: 1.44, 2.24), self-care (IRR: 1.25, 95 % CI: 1.08, 1.44) and household activities (IRR: 1.39, 95 % CI: 1.08, 1.78) after adjusting for previous falls and covariates. Multiple previous falls independently predicted limitations in mobility (IRR: 1.72, 1.30, 2.27), self-care (IRR: 1.40, 95 % CI: 1.19, 1.66) and household activities (IRR: 1.36, 95 % CI: 1.01, 1.83) after adjusting fear of falling and covariates.

Conclusions

Fear of falling seems to be as important as multiple previous falls in terms of limiting older adults’ daily activities.