Impact of changes in leisure activities on incident disability among older adults: a nationwide cohort study.

Background: As research has shown that participation in leisure activities (LAs) is closely related to health outcomes in later life, we explored the associations between dynamic changes in LAs and disability in activities of daily living (ADL) in older people. Methods: We enrolled 11627 older adults free of disability from six waves in the Chinese Longitudinal Healthy Longevity Survey (1998, 2000, 2002, 2005, 2008, and 2011). All participants completed two consecutive LAs measurements (including six typical activities) in the first two waves and were divided into four categories according to the patterns of change: sustained low LA (n = 2931), LA increase (n = 1729), LA decrease (n = 1802), and sustained high LA (n = 5169). Incident ADL disability was identified using a total Katz index <6 points during each follow-up until 2018. We used Cox proportional hazard regressions to test the association between changes in LAs and disability, with demographic characteristics, health behaviours, and chronic diseases included as covariates. Results: During 51991.85 person-years of follow-up, 3717 participants developed ADL disability. Compared with the sustained low group, the adjusted hazard ratio (aHR) of disability for the sustained high group, LA increase group, and LA decrease group were 0.62 (95% CI = 0.57-0.69), 0.66 (95% CI = 0.59-0.74), and 1.01 (95% CI = 0.91-1.11), respectively. Specifically, increased participation in outdoor activities, keeping domestic animals or pets, and playing cards or mahjong were factors associated with a lower risk of disability. The main results remained stable in the subgroup and sensitivity analyses. Conclusion: Maintaining high participation and increasing participation in LAs are associated with a lower risk of ADL disability in community-dwelling older individuals. Therefore, promoting participation in LAs represents a practical strategy to prevent ADL disability, thereby contributing to healthy ageing.