Psychosocial and cognitive profiles associated with health-related quality of life and healthy aging among community-dwelling older adults: a latent profile analysis.
Community-dwelling older adults differ in their social, psychological, and cognitive resources, which may influence health-related quality of life and healthy aging. Variable-centered approaches may not fully capture this heterogeneity. This study aimed to identify psychosocial and cognitive profiles among community-dwelling older adults and examine differences in health-related quality of life and healthy aging across profiles.
Methods
This study was a secondary analysis of de-identified data from a nationwide cross-sectional survey of 510 community-dwelling older adults in Korea. Latent profile analysis was conducted using social network, perceived social support, depressive symptoms, and subjective cognitive function as profile indicators. Health-related quality of life, measured by the Physical Component Summary and Mental Component Summary of the 12-item Short Form Health Survey, and healthy aging were examined as distal outcomes. Covariate effects of age, sex, education years, living status, and economic status were removed using linear regression residuals. Welch's one-way analysis of variance and Games-Howell post hoc tests were used to compare residualized outcomes across profiles.
Results
A five-profile solution was selected based on model fit, entropy, minimum profile size, parsimony, and interpretability. The profiles were labeled as the High-Depression Vulnerable Group (n = 29), Moderate-Depression Socially Connected High-Resource Group (n = 53), Low-Depression Socially Constrained Group (n = 129), Elevated-Depression Intermediate-Resource Group (n = 41), and Low-Depression, High-Support, Limited-Network Group (n = 258). Profile membership was significantly associated with the Physical Component Summary, F(4, 107) = 81.66, p < .001; Mental Component Summary, F(4, 107) = 10.27, p < .001; and healthy aging, F(4, 110) = 53.51, p < .001. The Low-Depression, High-Support, Limited-Network Group had the highest healthy aging score, significantly exceeding all other profiles. Physical health-related quality of life was similarly high in the Moderate-Depression Socially Connected High-Resource Group and the Low-Depression, High-Support, Limited-Network Group. The High-Depression Vulnerable Group had the lowest Physical Component Summary and healthy aging scores.
Conclusions
Community-dwelling older adults showed distinct psychosocial and cognitive profiles that were differentially associated with health-related quality of life and healthy aging. Healthy aging was most favorable in the group characterized by limited social network resources but high perceived social support, low depressive symptoms, and favorable subjective cognitive function. These findings suggest that healthy aging may depend not only on social network resources, but also on perceived support, depressive symptom burden, and subjective cognitive function. Person-centered assessment may help identify older adults who require tailored strategies to promote quality of life and healthy aging in community settings.
Objective To investigate the longitudinal dynamic relationships among frailty, depression, and self-perceptions of aging in community-dwelling older adults, to analyze the mediating role of depression between frailty and aging cognition, and to provide a theoretical basis for physical and mental health interventions for this population. Methods A longitudinal follow-up research design was adopted, involving three waves of surveys (T1, T2, T3) conducted with 286 community-dwelling older adults. Assessments were performed using the Frailty Phenotype, a depression scale, and a brief version of the Self-Perceptions of Aging Scale. SPSS 26.0 was used for descriptive statistics and correlation analysis, while Mplus 8.3 was employed to construct cross-lagged panel models. Covariates such as age, gender, education level, the number of chronic diseases, and cognitive function were controlled. Results The cross-lagged panel model demonstrated good fit indices. With the exception of baseline (T1) self-perceptions of aging not significantly predicting the midterm (T2) level, all other core variables exhibited significant temporal stability. Controlling for autoregressive effects and covariates, significant bidirectional predictive relationships emerged: T1 frailty significantly predicted T2 depression, and T2 depression significantly predicted T3 frailty; T1 depression significantly predicted T2 self-perceptions of aging, and T2 self-perceptions of aging significantly predicted T3 depression. Furthermore, the direct predictive path from frailty to self-perceptions of aging was not significant, suggesting that depression may constitute an indirect pathway linking frailty and self-perceptions of aging. Conclusion This study supports a dynamic psychosomatic interaction pattern among frailty, depression, and self-perceptions of aging in community-dwelling older adults. Depression serves as a core hub connecting physiological frailty and subjective aging cognition. The findings support the Psychosomatic Interaction Theory (PIT) and Stereotype Embodiment Theory (SET). These results suggest that community nursing practice should emphasize early screening and intervention for depressive symptoms. Targeting this potentially important depressive pathway may help interrupt the adverse cycle of “physiological frailty – psychological depression - negative aging cognition” among older adults can be disrupted.
Yongwei Liu, Yuyang Luo, Junjun Sun et al.· Frontiers in Public Health· 0 citations
Healthy ageing is commonly defined in relation to functional ability, intrinsic capacity and environmental context. However, less is known about how environmental engagement, mental wellbeing, physical functional indicators and religious/spiritual resources combine into healthy ageing profiles across residential settings. This study examined these associations in community-dwelling and institutionalized older adults.
This cross-sectional, exploratory comparative study included 136 older adults in Hungary: 78 community-dwelling participants and 58 residents of long-term care institutions. Environmental engagement was operationalized as self-reported weekly frequency of spending at least 30 min in natural environments. Mental wellbeing was assessed using the World Health Organization Five Well-Being Index (WHO-5), religiosity using the Centrality of Religiosity Scale (CRS), movement quality using the Functional Movement Screen (FMS), and muscular strength using handgrip dynamometry. Analyses included group comparisons, correlations, multiple regression, exploratory cluster analysis and an exploratory thresholded correlation network.
Community-dwelling participants were younger and showed more frequent nature exposure, higher wellbeing and better FMS scores than institutionalized participants, whereas institutionalized participants reported higher religiosity. Nature exposure was associated with WHO-5 wellbeing (
r
= 0.220,
p
= 0.010) and FMS (
r
= 0.320,
p
< 0.001). FMS was associated with handgrip strength (
r
= 0.320,
p
< 0.001). The wellbeing regression model explained only a modest proportion of variance (R² = 0.086), and the association between nature exposure and wellbeing did not remain statistically significant after adjustment (β = 0.162,
p
= 0.072). A three-cluster solution was retained as the most interpretable exploratory phenotype structure, despite k = 2 showing somewhat stronger numerical cluster-validity indices. In the exploratory network, FMS had the highest centrality, while religiosity was peripheral.
The findings suggest that healthy ageing in this sample was characterized by multidimensional, heterogeneous and interrelated profiles rather than residential status alone. Functional movement quality and environmental engagement were associated with several healthy ageing indicators, but causal mechanisms cannot be inferred. The results should be interpreted as exploratory and hypothesis-generating, warranting confirmation in larger longitudinal and intervention studies.
Péter Fritz, Laura Csány, Regina Krasznai et al.· BMC Geriatrics· 0 citations
ObjectiveThis study aimed to identify subgroups of stroke survivors based on multiple-adverse health conditions and determine the potential mediation effects of mental health in their relationship with health-related quality of life.DesignA cross-sectional study.SettingThree tertiary hospitals in Tianjin, China.ParticipantsA total of 558 stroke survivors were recruited between March and June 2023.Main measuresMultiple-adverse health conditions (multimorbidity, frailty and disability) were assessed using the age-corrected Charlson Comorbidity Index, FRAIL Scale, and Barthel Index. Mental health was measured with Patient Health Questionnaire-4, and health-related quality of life was evaluated using the EuroQol 5-dimension 5-level scale. Latent profile analysis identified subgroups, and mediation analysis explored mental health's role.ResultsThree subgroups were identified: Mild (65.4%, n = 365), Moderate (17.4%, n = 97), and Severe (17.2%, n = 96). Mediation analysis showed that, compared with the Mild subgroup, survivors in the Moderate subgroup (β = 0.138, 95% CI: 0.055 to 0.232) and the Severe subgroup (β = 0.217, 95% CI: 0.113 to 0.316) exhibited worse mental health, and poorer mental health was associated with lower health-related quality of life (β = -0.119, 95% CI: -0.170 to -0.075).ConclusionsThis study suggests heterogeneity in multiple-adverse health conditions and indicates that mental health may partially account for the association between these conditions and health-related quality of life in stroke survivors. The findings highlight the need for further research into subgroup-specific interventions-with particular attention to mental health-to determine whether such approaches could improve health-related quality of life.
With the acceleration of global population aging, mental health issues among older adults have become increasingly prominent. Aging anxiety, defined as apprehension regarding the aging process and associated physiological, psychological, and social role losses, significantly impacts the quality of life and health of the older adults. Physical exercise has been shown to be associated with better physical and mental health of older adults, yet the theoretical psychological mechanisms underlying their association remain insufficiently clarified. Therefore, this study aims to construct and test a serial mediation model to explore the statistical sequential indirect associations linking physical exercise to aging anxiety via self-efficacy and health anxiety.
This study employed a cross-sectional survey design, targeting Chinese adults aged 60 and above. A total of 721 valid questionnaires were collected. Data were gathered using the *Physical Activity Rating Scale (PARS-3)*, the Aging Anxiety Scale, the General Self-Efficacy Scale, and the Health Anxiety Scale. Data analysis was performed using SPSS 27.0 and PROCESS 4.0 software. Common method bias tests, correlation analyses, multiple linear regression, and Bootstrap mediation effect tests were conducted to examine the relationships among physical exercise, self-efficacy, health anxiety, and aging anxiety, as well as the mediating pathways.
Correlation analysis revealed that physical exercise was significantly negatively correlated with aging anxiety (
r
= −0.232,
p
< 0.001), significantly positively correlated with self-efficacy (
r
= 0.225,
p
< 0.001), and significantly negatively correlated with health anxiety (
r
= −0.193,
p
< 0.001). Aging anxiety was negatively correlated with self-efficacy (
r
= −0.474,
p
< 0.001) and positively correlated with health anxiety (
r
= 0.483,
p
< 0.001); self-efficacy and health anxiety were significantly negatively correlated (
r
= −0.420,
p
< 0.001). Mediation analysis further revealed that the total effect of physical exercise on aging anxiety was −0.0525 (95% CI: [−0.0685, −0.0364]); the direct effect was −0.0221 (95% CI: [−0.036, −0.0081]), accounting for 42.10% of the total effect, and the total statistical indirect effect was −0.0304 (95% CI: [−0.040, −0.0216]), accounting for 57.90% of the total effect. The independent statistical indirect effect of self-efficacy was the most prominent (indirect effect = −0.0159, 95% CI: [−0.022, −0.0105]; accounting for 30.28% of the total effect). The indirect effect through health anxiety alone was −0.0078 (95% CI: [−0.0143, −0.0023]; 14.86%), and the serial indirect effect was −0.0067 (95% CI: [−0.0095, −0.0044]; 12.76%).
This study supports that physical exercise is not only directly associated with lower aging anxiety in older adults but also shows significant statistical indirect associations through a potential serial pathway involving self-efficacy and health anxiety. Self-efficacy, as a crucial psychological resource, exhibits the strongest statistical indirect effect between physical exercise and aging anxiety. The findings deepen the understanding of the statistical association patterns through which physical exercise is linked to better mental health in older adults. They provide a theoretical basis and practical reference for designing targeted exercise interventions to mitigate aging anxiety among the older adults.
Wenhai Yu, Guo-Xi Ye· Frontiers in Public Health· 0 citations
Background: Depressive symptoms have become a significant public health issue faced by middle-aged and older adults in China. Although previous studies have primarily focused on demographic and socioeconomic factors, the association between modifiable lifestyle behaviors and depressive symptoms still requires further investigation. Objective: To examine the associations between sleep duration, physical activity, digital participation, social participation, and depressive symptoms as well as life satisfaction among middle-aged and older adults in China. Methods: A cross-sectional analysis was conducted using data from the 2020 China Health and Retirement Longitudinal Survey (CHARLS). Depressive symptoms were defined as CES-D-10 scores ≥10, with 13,576 individuals included in the analysis sample. Adjusted prevalence ratios (aPRs) were estimated using modified Poisson regression, while ordinal logistic regression was employed to analyze life satisfaction. The analysis controlled for covariates such as demographics, socioeconomic status, and health status, and accounted for the complex sampling design. Results: The weighted prevalence of depressive symptoms was 44.5%. Sleep deprivation (<7 h/day) was significantly associated with elevated depressive symptoms (aPR = 1.49, 95% CI: 1.33–1.68); participation in recreational activities was significantly associated with reduced depressive symptoms (aPR = 0.86, 95% CI: 0.77–0.96); adequate physical activity was associated with a higher prevalence of elevated depressive symptoms (aPR = 1.17, 95% CI: 1.04–1.32); watching videos (aPR = 0.87, 95% CI: 0.76–0.99) and playing online games (aPR = 0.65, 95% CI: 0.50–0.83) were significantly associated with reduced depressive symptoms; and overall internet use was correlated with lower life satisfaction (OR = 0.90, 95% CI: 0.81–1.00). Women, rural residents, and low-income groups exhibited higher prevalence of elevated depressive symptoms. Conclusion: Sleep deprivation, as well as different types of social engagement, physical activity, and digital behavior, exhibit distinct associations with depressive symptoms in middle-aged and older adults. Behavioral intervention strategies targeting sleep hygiene, leisure activities, and tailored digital behaviors warrant further attention.
Shu Wang, Y. Shirayama, Ishtiaq Ahmad et al.· Behavioral Science· 0 citations
Background: Clinically significant depressive symptoms and self-reported mental health-related conditions are increasing among older adults in China. Although socioeconomic status (SES) is an important upstream determinant, nationally representative evidence on its longitudinal association with mental health-related outcomes and related behavioral pathways remains limited.
Objective: To examine the longitudinal association between socioeconomic status and incident mental health-related outcomes among older Chinese adults, and to assess whether social participation and sleep duration partly explain this association.
Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2018), this study included 5,465 adults without baseline depressive symptoms or self-reported mental health-related conditions. SES was derived from latent class analysis of household income, educational attainment, and employment status, rather than from employment status alone. Incident mental health-related outcomes were identified during follow-up using Center for Epidemiologic Studies Depression Scale-10 screening results and self-reported physician diagnosis. Cox proportional hazards models, subgroup analyses, and pathway analyses were conducted.
Results: Compared with the high-SES class, low SES was associated with a higher risk of incident mental health-related outcomes in the fully adjusted model (hazard ratio: 1.40, 95% confidence interval: 1.15–1.69), with a stronger association among women, while residence- and body mass index-specific patterns were interpreted cautiously. Social activity accounted for 6.1% of the SES–outcome association, whereas sleep duration showed a small suppressor effect (−2.6%).
Conclusion: These findings suggest that socioeconomic disadvantage is associated with elevated mental health-related risk in later life, partly through reduced social participation. The role of sleep requires further investigation using more detailed sleep measures.
Zhuoying Chen· Health Psychology Research· 0 citations
