Perceived Age Discrimination and Its Association With Functional Dependency, Depressive Symptoms, and Health Care Use Among Older Adults: A Cross-Sectional Study
Abstract
Objective: To investigate the complex relationships between perceived age discrimination, functional independence, depressive symptoms, sociodemographic characteristics, and health care use patterns among individuals aged 60 years and older using advanced distribution-focused regression modeling. Methods: This cross-sectional study included 361 older adults recruited from 2 primary family health centers between July and October 2023. Data were collected via face-to-face interviews using a 57-item structured questionnaire incorporating the Ageism Survey, the Lawton and Brody Instrumental Activities of Daily Living (IADL) Scale, the Geriatric Depression Scale–Short Form, and relevant clinical covariates. Multivariable two-part hurdle and quantile regression models were utilized to examine the predictors across the conditional distribution of ageism scores. Results: Perceived ageism scores were generally low across the cohort, characterized by a profound flooring effect at zero. Marital status, education, income, and prior employment were significantly associated with perceived age discrimination. In stage 1 logistic regression, lower functional independence (Odds Ratio [OR], 0.82; 95% CI, 0.69-0.97; P = .02), higher depressive symptoms (OR, 1.10; 95% CI, 1.01-1.20; P = .03), widowhood (OR, 2.11; 95% CI, 1.21-3.68; P = .01), and more frequent hospital outpatient visits (OR, 1.14; 95% CI, 1.02-1.26; P = .02) were linked to a higher likelihood of reporting perceived ageism, whereas frequent family physician visits showed an inverse association (OR, 0.92; 95% CI, 0.86-0.99; P = .02). In stage 2 quantile regression among those with positive scores (n = 233), the association between depressive symptoms and perceived ageism intensified monotonically across distribution tiers (β = .26 at τ = .25 to β = .72 at τ = .75; P < .05). Conclusions: The study highlights perceived ageism as an important factor influencing both mental well-being and functional independence in older adults, suggesting that anti-ageism policies should integrate mental health screenings and functional preservation programs within primary care frameworks.