Age-friendly community environments and depressive symptom trajectories among middle-aged and older adults in China: Evidence from the China Health and Retirement Longitudinal Study (CHARLS).

Abstract

How age-friendly community environments contribute to reducing the risk of developing adverse depressive trajectories remains an important area for scholarly inquiry. Using the China Health and Retirement Longitudinal Study (CHARLS) data from 2011 to 2020, this study employed Group-based trajectory modeling (GBTM) to identify depressive symptom trajectories, and multinomial logistic regression to examine associations between baseline age-friendly community environments and those trajectories among middle-aged and older adults, considering health heterogeneity and urban-rural differences. Three trajectories were identified: stable low, moderate increasing, and high depressive symptoms. Chronic diseases, limitations in Instrumental Activities of Daily Living (IADL) and poor self-rated health were fundamental risk factors for adverse trajectories. After covariate adjustment, higher overall age-friendly community scores were associated with lower risks of adverse trajectories. Specifically, connectivity-related domains, including communication and information infrastructure, transportation, neighborhood support, and facilities and associations for social participation, showed significant protective associations. These protective associations were stronger among individuals with better self-rated health or a lower chronic disease burden, but weaker among those with greater health disadvantages. Stratified estimates also suggested that neighborhood support may be more protective among individuals with IADL limitations. Protective associations were more evident in rural areas, especially for communication and information infrastructure, facilities and associations for social participation, housing, and neighborhood support. Building age-friendly communities should move beyond universal resource improvement and toward community support tailored to health-vulnerable older adults and urban-rural differences.