Leisure participation and mental health among middle-aged and older adults with physical disabilities: a systematic review

PURPOSE

To examine the effects of leisure participation on mental health for middle-aged and older adults with physical disabilities.

MATERIALS AND METHODS

A systematic review conducted in March-May 2022 with an updated search in February 2024 retrieved data from MEDLINE, CINAHL, PsycInfo, and EMBASE. Inclusion criteria included a study population with a mean age ≥45 years and with physical disability, and original, peer-reviewed literature. Exclusion criteria included non-community-dwelling participants, participants outside the specified age range, review studies, intervention studies not focused on leisure or intrinsically motivated activities, and studies without full text. The Oxford 2011 Levels of Evidence, NIH study quality assessment tool, and Cochrane ROBINS-I tools were used to assess the evidence strength and the risk of bias. A data extraction table was created to analyze and synthesize the results.

RESULTS

Eleven articles with 18,681 total participants were thoroughly reviewed. Most studies were longitudinal survey, cohort, and cross-sectional studies. Evidence indicates that leisure participation benefits mental health (depression, anxiety, happiness, and well-being) and other health-related outcomes.

CONCLUSIONS

Findings should be interpreted with caution due to lack of high-level evidence. Future research should consider alternative study designs in addition to RCTs to better capture the individualized nature of leisure activities.

Long-term functional ability trajectories and mental health among older people before and after the COVID-19 pandemic onset in Chile

OBJECTIVES

Despite the advances in understanding the complex association between functional abilities and mental health in old age, studies have overlooked two important aspects. First, traditionally, research has employed cross-sectional designs, measuring limitations at a single time point. Second, most gerontological studies on this field have been conducted before the COVID-19 pandemic onset. This study aims to explore the association between diverse long-term functional ability trajectories across late adulthood and old age, and older people's mental health in Chile, before and after the COVID-19 pandemic onset.

METHODS

We use data from the population-representative and longitudinal 'Chilean Social Protection Survey', sequence analysis to reconstruct functional ability trajectory types from 2004 to 2018, and bivariate and multivariate analyses to measure their association with depressive symptoms in early 2020 (N = 891) and late 2020 (N = 672). We analyzed four age groups defined by their age at baseline (2004): people aged 46-50, 51-55, 56-60, and 61-65.

RESULTS

Our findings indicate that erratic or equivocal patterns of functional limitations across time (with people transiting back and forth between low and high levels of limitations) show the worst mental health outcomes, both before and after the pandemic onset. Prevalence of people with depression increased after the COVID-19 onset in most groups, being particularly high among those with previous equivocal functional ability trajectories.

CONCLUSIONS

The relationship between functional ability trajectories and mental health calls for a new paradigm, moving away from age as the main policy guide, and highlighting the need to adopt strategies to improve population-level functional status as an efficient policy to address the challenges of population aging.

Anxiety, depression and stress among internally displaced persons and host community in an armed conflict region: A comparative study

This study compares the psychological profile of Internally Displaced Persons (IDPs) and individuals living in host communities in the war-affected setting. We conducted a cross-sectional survey from October-November 2019. Subjects were recruited from six IDPs camps and the surrounding host communities within the metropolis of Maiduguri, Nigeria by convenience sampling. Data were collected using the Hausa version of Depression Anxiety Stress Scale-21, and analysed by logistic regression using adjusted odds ratio (AOR) at 95% Confidence Interval (CI). A total of 562 subjects were recruited. Living in IDP camp was the most significantly predictor of depression, anxiety, and stress. The common predictors were living in an IDP camp, and marital status (separated). Aged 18-29years was a protective factor compared to those ≥50years. Living in IDP camps, separated from partners, lack of education and pre-conflict employment were significant predictors of depression, anxiety and stress.

Less Social Participation Is Associated With a Higher Risk of Depressive Symptoms Among Chinese Older Adults: A Community-Based Longitudinal Prospective Cohort Study

OBJECTIVE

We aimed to examine the association between social participation and depressive symptoms among Chinese older people aged 65 years or above to supplement limited studies in China on this topic.

METHODS

This community-based longitudinal prospective cohort study used the data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS, baseline in 2014 and a follow-up in 2018). Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale. Social participation was assessed using a composite index by considering the frequency for the two types of social activity: organized social activities and informal activities. Pearson's χ2 test was used to correlate the characteristics of participants with social participation or depressive symptoms. Log-binomial regression models were used to assess the association between social participation and the risk of depressive symptoms.

RESULTS

The incidence of depressive symptoms was 28.8% among 2,200 participants in 2018 after a 4-year follow-up. Participants with no social participation (32.6%), organized social activities (30.6%), or informal social activities (31.2%) were more likely to have depressive symptoms. After the adjustment of demographic factors, socioeconomic status, lifestyle habits, and health status, in comparison with older people who often engaged in social participation, organized social activities, and informal social activities, the risk of depressive symptoms was 45% [adjusted risk ratio (aRR): 1.45, 95% CI: 1.16-1.82], 42% (aRR: 1.45, 95% CI: 1.02-2.00), and 29% (aRR: 1.29, 95% CI: 1.02-1.99) higher among older people with no social participation and who never engaged in organized social activities and informal social activities, respectively.

CONCLUSIONS

This study showed that the lack of social participation, including organized social activities and informal social activities, was associated with a higher risk of depressive symptoms after 4 years among older adults in China. Our findings shed lights into the feasibility of promoting social participation to reduce the risk of depressive symptoms and promote longevity and healthy aging among older adults.

Impact of Pain and Psychosocial Factors on Frailty Among Older Adults With Physical Functional Limitations: A Cross-Sectional Study

AIMS

The objective of this study was to determine the prevalence of frailty and pain among older adults with physical functional limitations in China. We also assessed the impact of pain and psychosocial determinants on frailty among this vulnerable population.

DESIGN

This study was a cross-sectional study.

SETTING AND PARTICIPANTS

Totally, 2,323 Chinese elders with physical functional limitation were enrolled.

METHODS

Physical functioning was assessed by the Barthel Index, participants who reported "often troubled with pain" were further asked about the intensity of their pain using a 1-10 numeric rating scale, and frailty was assessed by the Assessment of frailty FRAIL scale. The impact of pain and psychosocial factors on frailty was assessed by multivariable binary logistic regression.

RESULTS

The prevalence of frailty and pain were 30.9% and 46.1%, respectively. Compared with subjects who reported no pain, those who reported mild (odds ratio [OR] = 1.70, 95% confidence interval [CI] = 1.21-2.31), moderate (OR = 2.10, 95% CI = 1.53-2.82), or severe pain (OR = 2.31, 95% CI = 1.56-3.40) tended to be more vulnerable to frailty. Furthermore, compared with participants with positive psychosocial determinants, those with negative psychosocial determinants seemed more likely to be frail.

CONCLUSIONS

These findings suggest that the incidence of pain, negative psychosocial status, and frailty were prevalent, and the presence of pain and negative psychosocial factors increased the risk of frailty among older adults with physical functional limitation.

Chronic conditions and depressive symptoms in older adults: the mediating role of functional limitations

BACKGROUND

Depressive symptoms, chronic conditions, and functional limitations are common in older adults. Several studies have examined the relationship between chronic conditions or functional limitations and depressive symptoms separately. However, little is known about how much of the effect of chronic conditions on depressive symptoms is due to the functional limitations resulting from such conditions.

METHODS

This paper examined the longitudinal association of chronic conditions and functional limitations with depressive symptoms in older adults aged 65 and over in the USA using the data from the 2012 wave and 2014 wave of the Health and Retirement Study (HRS). Mediation analysis was used to examine the mediation effects of 2012 functional limitations on the relationship between 2012 chronic conditions and 2014 depressive symptoms controlling for other measures including gender, age, race, education, marital status, and BMI.

RESULTS

Results revealed that chronic conditions and functional limitations were significantly associated with depressive symptoms. There was a 13.7% mediation effect when 2012 functional limitations were added as a mediator on the relationship between 2012 chronic conditions and 2014 depressive symptoms.

CONCLUSION

Functional limitations mediate the relationship between chronic conditions and depressive symptoms. Preventing or managing functional limitations may help reduce depressive symptoms in older adults with chronic conditions.

Prevalence and predictors of depressive symptoms in older adults with cancer

INTRODUCTION

Older adults with cancer are at risk of developing depressive symptoms. However, little is known about the prevalence and predictors of depressive symptoms in older adults with cancer.

MATERIALS AND METHODS

This study examined the prevalence and predictors of depressive symptoms among older adults with cancer in the United States using the data from the 2012 and 2014 wave of the Health and Retirement Study. This analysis included 1799 older adults aged 65 and over with a self-reported diagnosis of cancer. Multivariate regression analysis was used to examine the predictors of depressive symptoms. The main predictors included age, gender, race, education, marital status, chronic conditions, and functional limitations.

RESULTS

Results revealed that the prevalence of depressive symptoms in older adults with cancer was 14.9%. Results of Poisson regression revealed that greater age, belonging to a race other than White or African American, not being married, presence of more chronic conditions, and higher levels of functional limitations were associated with higher levels of depressive symptoms.

DISCUSSION

The prevalence of depressive symptoms is high in older adults with cancer and several factors predict depressive symptoms in this population. Individuals who are at high risk of developing depressive symptoms should be identified and appropriate timely interventions should be initiated to reduce the rates of depressive symptoms in older adults with cancer.