Contextual factors influence how older adults perceive and adapt to chronic health conditions. We examined the impact of chronic health conditions on trajectories of depressive symptoms among older Chinese adults and investigated whether age-friendly communities buffer this effect.
We used panel data from the China Health and Retirement Longitudinal Study from 2011 to 2018, including 6122 adults aged ≥50 years (22 198 observations). Factor analysis of mixed data (FAMD) was performed to construct composite variables of community characteristics. The cross-level interactions between community variables and multimorbidity were included in growth curve models to assess the moderating effects.
Individuals with multimorbidity had Centre for Epidemiologic Studies Depression Scale (CES-D) scores that were, on average, 1.60 points higher (95% CI 1.31 to 1.89) than those without chronic conditions, indicating a relatively modest effect size. Associations with depressive symptoms were weaker in more favourable community environments and among individuals with higher participation (all P for interaction<0.001). For multimorbidity, β coefficients were smaller in areas with better infrastructure (1.50 vs 1.73), stronger social services (1.47 vs 1.85) and higher participation (1.47 vs 2.09). A similar pattern was observed for individuals with a single condition, with smaller β coefficients in areas with better infrastructure (0.41 vs 0.79), stronger social services (0.35 vs 0.78) and higher participation (0.35 vs 0.89).
Age-friendly environments may ameliorate the effects of multimorbidity on depressive symptoms. Interventions can target modifiable community-level factors to better support older adults with chronic conditions.