Mind, Mood, and Mobility: Rethinking Functional Disability Prevention in Older Adults on the Basis of a Longitudinal Cohort From CHARLS

Abstract

Background Disability among older adults in China is becoming an increasing public health challenge due to rapid population aging. We aim to investigate how cognitive deficits, depression, and physical function limitation jointly contribute to the onset and progression of disability. Methods We included 4226 individuals aged ≥60 years from the China Health and Retirement Longitudinal Study, who were followed for a mean of 7.8 years (2010–2020). Physical function, cognition, and depressive symptoms were assessed. Outcomes included incident activities of daily living (ADL) disability and the number of ADL and instrumental ADL disabilities. Cox regression, linear mixed‐effects models, and structural equation modeling were applied. Results Having ≥2 conditions of cognitive deficits, depression, and physical function limitation concurrently at baseline was associated with a higher risk of incident ADL disability (hazard ratio [HR]2 versus 0, 1.70 [95% CI, 1.44–2.00]; HR3 versus 0, 2.10 [95% CI, 1.65–2.68]) and a faster annual increase in ADL/instrumental ADL limitations compared with those without (β2×time=0.010 [95% CI, 0.007–0.013]; β3×time=0.014 [95% CI, 0.010–0.019]). The association between physical function limitations and longitudinal ADL/instrumental ADL accumulation appeared to be mediated by the biannual rate of cognitive decline and increases in depression scores. Conclusions The co‐occurrence of cognitive deficits, depression, and physical function limitations may synergistically drive long‐term disability. Our findings highlight the importance of early screening and holistic management of cognitive, mental, and physical health to reduce the burden of disability in aging populations.