Network analysis of the relationships among activities of daily living disability, cognitive impairment, and depression in Chinese older adults.

BACKGROUND: As the aging population in China continues to grow, Activities of Daily Living (ADL) disability, cognitive impairment, and depression have become prevalent health issues among older adults. These three factors are closely related, but the specific interactions between their symptoms have not been fully explored. This study aims to construct a network model that links ADL, cognitive function, and depression in older adults, and to identify the central and bridging symptoms within this network. METHODS: This study utilized data from 8,762 individuals aged 60 and above from the China Health and Retirement Longitudinal Study (CHARLS). The ADL scale, the Mini-Mental State Examination (MMSE), and the Center for Epidemiologic Studies Depression Scale (CESD-10) were employed to assess ADL, cognitive function, and depression. Network analysis was performed to examine the network structure, identify central and bridging symptoms, and assess the stability of the network of ADL, cognitive function, and depression. Additionally, comparisons of the networks based on gender, age, and chronic disease status were conducted. RESULTS: In the network of ADL, cognitive function, and depression in older adults, the central symptoms identified were "Felt depressed" (CESD3, strength = 1.118), "Felt everything I did was an effort" (CESD4, strength = 1.018), and "Could not get on" (CESD8, strength = 0.969). The bridging symptoms were "IADL" (ADL2, bridge strength = 0.453), "BADL" (ADL1, bridge strength = 0.316), and "Orientation" (MMSE, bridge strength = 0.242). The strongest edge within the subgroups of nodes was observed between "Immediate recall" and "Delayed recall" (MMSE4-MMSE5, edge weight = 0.490), while the strongest edge between subgroups of nodes was between "IADL" and "Felt everything I did was an effort" (ADL2-CESD4, edge weight = -0.091). Furthermore, significant differences in network structures were found between genders (P < 0.05), and both global intensity and network structures differed significantly based on chronic disease status (P < 0.05). CONCLUSIONS: The central and bridging symptoms identified within the network could serve as the most effective intervention targets for addressing ADL disability, cognitive impairment, and depression in older adults. Clinical interventions should consider the differences in symptom expression related to gender and chronic disease status.