Trends of impairment of the activities of daily living in Chinese elderly: An age-period-cohort analysis

Abstract Background Based on age, period, and cohort, this study aimed to understand the trend of impairment of activities of daily living (ADL) and its influencing factors in older adults in China and to provide a basis for the development of appropriate interventions. Methods This longitudinal follow-up study was conducted on a sample of 40748 cases aged ≥ 60 years from the China Family Panel Studies (CFPS) database of 6 periods, using the six-item ADL scale to measure impaired ability to perform daily activities in older adults. Incorporating independent variables affecting ADL impairment in older adults based on the health ecology theory, a stratified age-period-cohort mixed-effects model was used to analyze the factors influencing impaired ADL in older adults. Results Age, different periods, and birth cohort had an independent effect on females suffering from chronic diseases, having lower life satisfaction (dissatisfied, very dissatisfied), living in the western region, residing in rural areas, having per capita household income levels of middle-high, middle-low, lower-middle, lower-middle, and going to specialized and general hospitals were risk factors for ADL impairment in older adults. Smoking, drinking alcohol, exercising, having high life satisfaction (satisfied), being married, having higher education, and having urban/rural/rural residents’ health insurance and employee health insurance were protective factors for ADL impairment in older adults. Conclusions It is important to pay further attention to the current situation of ADL impairment in older adults from the perspective of the whole life cycle and the whole population and to take timely and targeted intervention strategies and preventive measures to improve the health of older adults in different dimensions from the individual to the macro level.