How do functional disabilities affect depression among older adults in the United States? This study in the Disability & Health Journal studies differences across racial and ethnic groups. It identifies key factors that can support mental wellbeing in this population.
This plain language summary is part of a new series sharing highlights from the Disability and Health Journal.
Why was this study done?
Many older adults in the U.S. face functional disabilities. These are challenges in performing daily tasks essential for independent living. They impact 15% to 34% of those aged 50 and up. Research shows that these disabilities affect various racial and ethnic groups differently. This can result in higher rates of depression. Disability and depression affect each other. However, studies show that having a physical disability is more likely to cause depression than the reverse. Health disparities in racial and ethnic groups raise healthcare costs and strain the U.S. economy. Addressing mental health issues for people with disabilities is a key public health priority.
There isn’t much research on how race and ethnicity influence the effects of disabilities on mental health in middle-aged and older adults. Most past studies on functional disabilities and depression focused on Black and White Americans. They often used small samples or data from one regional area. This means the results may not apply to the entire U.S. population. Also, many of these studies left out Hispanic individuals. They are the fastest-growing older minority group in the country. Aging impacts both physical and mental health. So, we must consider how disabilities affect people at different life stages. Older adults usually have disabilities that last longer. In contrast, depression is more common during midlife. This means that the connection between disability and depression can vary by race and ethnicity. It could also vary between middle-aged and older adults.
Previous studies on people with disabilities concentrated on risks to physical health. They focused on things like hospital visits and nursing home stays. Additionally, this study explores whether getting help with daily tasks changes the outcomes, as well as the impact of race and ethnicity on mental health in older adults with disabilities. The outcomes could help improve public health strategies and policies. These findings could improve support systems and reduce mental health gaps for older adults in the U.S.
How was this study done?
This study looks at data from a large group of U.S. adults aged 51 and older, from the Health and Retirement Study (HRS), done every two years by the University of Michigan. This group represents the diversity of the national population, which enhances our understanding of these issues. For this study, researchers used data from 2016 and 2018. The sample started with 15,831 participants aged 51 and up. They responded in both years. Yet, researchers excluded certain groups, including:
- 653 people who had proxy interviews
- 90 nursing home residents
- 3,200 people who had depression in 2016
- 123 people with Alzheimer’s or dementia
- 1,223 people who identified as “other” race due to small sample sizes
- 2,325 people missing key information on functional disabilities
After applying these exclusions, the final study sample included 8,217 participants. Among them, 7,475 participants (90.97% of the sample) had complete data for the analysis. The HRS data in this study do not have personal identifiers. Subject approval was not required.
The study notes depression as the main outcome. Researchers measure depression using a short version of the CES-D scale. This scale is often used to check for depression in older adults. This scale has eight questions about mood and behavior. Scorers assign responses a score from 0 to 8. The study defines depression as having a CES-D score of 3 or higher. Previous research has shown that this cutoff reliably identifies major depression.
The study also looks at functional limitations in 2016. These limitations are a key factor that affects the risk of depression. Functional limitations refer to difficulties with physical movement and daily activities. Researchers assessed 16 different tasks, grouped into three categories:
- Nagi Strength and Mobility Scale (5 tasks): This scale evaluates how well people can move. It includes walking, climbing stairs, bending or kneeling, reaching, and lifting objects.
- Lawton IADL Scale (5 tasks): This scale looks at challenges with daily tasks. It covers using the phone, managing money, taking medication, shopping, and cooking.
- Katz Activities of Daily Living (ADL) Scale (6 tasks): This scale measures essential self-care skills. It includes tasks like bathing, dressing, eating, getting in and out of bed, walking, and using the toilet.
Participants who had trouble with IADL or ADL tasks were asked if they got help and were split into two groups: those who got help and those who didn’t. This allowed the study to explore how help might change the link between disability and depression.
Moderator (Race-Ethnicity as a Factor)
Researchers considered race and ethnicity as factors. This means these aspects might affect how disabilities relate to depression. Researchers categorized participants into three groups:
- Non-Hispanic Black (NH Black) – 9.07% of participants
- Hispanic/Latino – 5.09% of participants
- Non-Hispanic White (NH White) – 85.84% of participants
These categories come from two survey questions: one on race (White, Black, or Other) and another on Hispanic/Latino identity. These classifications follow federal guidelines on race and ethnicity.
Other Factors Considered (Covariates)
The analysis focused on two age groups:
- Midlife adults (ages 51–64) – 44.74% of participants
- Older adults (65+) – 55.26% of participants
The study also looked at personal and health factors from 2016 for a full analysis, such as age, gender, living arrangement, socioeconomic status, BMI, education level, sleep quality, disability history, and big life changes.
What did this study show?
Researchers wanted to understand how disability and depression are connected for people of different racial and ethnic backgrounds. To do this, they measured how much a person’s disability affected their daily life. Disabilities were grouped into four categories: no disability, mild disability, severe disability with help, and severe disability without help.
These results suggest two important things. First, getting help with daily tasks could ease depression in older Americans. This means that community health programs and policies that make it easier to get help with disabilities might reduce depression in older people with severe disabilities. Second, helping make home environments more accessible can go a long way in terms of quality of life for older adults aging in place at home.
Data Highlights
- Nearly half (48.38%) of adults aged 51+ had no functional disabilities, while 51.62% had at least one.
- Among those with severe disabilities, 52% did not receive help with daily activities.
- Functional disabilities were most common in NH Black adults aged 51+ and in midlife groups.
- NH White midlife adults were the least likely to receive help with daily tasks.
There were big differences in how disabilities and depression were connected across racial and ethnic groups.
- NH Whites in both midlife and 51+ groups had a stronger link between increasing disability and depression than NH Blacks and Hispanics.
- For each level of increased disability:
- NH Blacks and Hispanics had a 19% higher chance of depression.
- NH Whites had a 36% higher chance of depression.
Learn more about the study
Participants of all ages who were non-Hispanic (NH) White and have functional disabilities were more likely to experience depression later compared to those without disabilities. Non-Hispanic whites were three times more likely to develop depression as their disability level increased, compared to NH Black and Hispanic individuals, even after accounting for other factors. However, this difference was not seen among older adults. For adults aged 51 and older who had severe disabilities but no assistance, NH Whites were 2.5 times more likely to experience depression than their minority counterparts. It did not find significant differences in depression risk by race-ethnicity among older adults aged 65 and up. This shows that the role of race-ethnicity in disability-related depression may fade with age.
The “age-as-leveler” theory says that health risks and resilience among racial-ethnic groups shift as people age. Young NH Blacks and Hispanics often face significant health disparities because of structural inequities. Still, their coping methods and life experiences can build resilience as they age. Midlife NH Whites may face more mental health challenges from disability. This could be due to less access to social support and caregiving. As people get older, health issues become common. This may lessen the differences in depression outcomes among racial and ethnic groups.
The study highlights caregiving’s importance. It finds that non-Hispanic Whites get less informal care than non-Hispanic Blacks and Hispanics. This may be due to cultural differences in caregiving norms. Future research should investigate how life-course factors shape the link between disability and mental health. This helps us understand the differences between racial and ethnic groups at different stages of aging. The study also found that midlife adults with severe disabilities, across all ethnic groups, who had no help were 2.5 times as likely to feel depressed.
Strengths and limitations of the study
Strengths
These findings have important implications for public policy and healthcare programs. Helping older adults with severe disabilities in their daily activities may lower depression. Healthcare programs, such as Medicare Accountable Care Communities and PACE, have their limits. They often miss out on covering midlife adults who might need assistance. It’s important to expand care models or start new programs for midlife and older adults with disabilities.
Another key point is the role of environmental adaptations that are vital for independent living and for enhancing mental well-being. Home upgrades, such as grab bars and ramps, can make daily tasks easier for people. Wheelchair-accessible spaces are helpful, too. They also lower stress from functional limits. Unsafe home environments can make disabilities worse. But, with the right changes, mobility and well-being can improve. These findings stress the need for better accessibility. This will improve the quality of life for individuals with disabilities.
Limitations
While this study provides valuable insights, there are some limitations. It used past data, which is outdated. Future studies should use new designs to better track long-term disability effects. The study only included community-dwelling adults. It did not consider those in nursing homes. It also didn’t provide clear details on how often and how much disability support was offered. Other elements, such as how chronic diseases are reported and socioeconomic factors, can also affect the results. Future research should fill these gaps. It’s especially important to study underrepresented racial-ethnic minority groups. This will help us see how disability and assistance impact mental health in various groups.