Analysis Of The Correlation And Mediating Effect Between Leisure Activities And Activities Of Daily Living Of The Elderly

Objective:With the accelerated aging process of Chinese population,health-related issues of the elderly become more and more important in society.Activities of daily living(ADL)are an important indicator to evaluate the health status of the elderly.Loss of activities of daily living will have a great impact on the mental health and quality of life of the elderly,and increase the economic burden on society.Leisure activities are an important part of the later life of the elderly,but the mechanism of the association between leisure activities and activities of daily living remains unclear.In this study,the participation level of leisure activities,activities of daily living,and cognitive function of the elderly were included in the longitudinal cohort study,and survival analysis and cross-lagged analysis were used to explore the correlation and interaction mechanism between leisure activities and activities of daily living of the elderly,and explore the possible mediating role of cognitive function in their interaction,which provides a theoretical basis for promoting the health status and improving the quality of life of the elderly.Methods:The data in this study are derived from the Chinese Longitudinal Healthy Longevity Survey(CLHLS).For the missing categorical variables and continuous variables in the original data,the majority and Full Information Maximum Likelihood Estimator(FIML)are used to estimate the processing.First,using the data of the 8 follow-up points of CLHLS 1998-2018,six prospective follow-up cohorts of activities of daily living including bathing,dressing,toileting,indoor transferring,continence and feeding were established,and the year in which the respondents were first surveyed was used as the baseline follow-up point.According to the participation of the elderly in leisure activities at the baseline follow-up point,the elderly was divided into three types of leisure activity participation: balanced,sedentary and physical.All activities of daily living were defined as the loss of the ability to perform the activity independently(i.e.death)based on the follow-up result of “need for help”.The Cox proportional risk regression model was used to analyze and compare the survival rate differences of the six activities of daily living of the elderly participating in three types of leisure activities: bathing,dressing,toileting,indoor transferring,continence and feeding.Then,using the data from the three follow-up points of CLHLS 2011-2018 to establish a cross-lagged panel model,and sequentially test the time-invariance of all cross-lagged paths and autoregression paths in the panel model to determine which paths need to be restricted and establish a stable model.On this basis,covariates were added,and the final cross-lagged panel model was screened and established to analyze the causal timing relationship between leisure activities and activities of daily living and the possible mediating role of cognitive function in it.Bootstrap method was used to test the size of the mediating effect.ADL and cognitive function were evaluated using the Katz Index of Daily Living Function Scale and Chinese Mini-Mental State Examination(CMMSE)in China,respectively.Results:(1)The association between leisure activities and the survival rate of activities of daily living: Six prospective follow-up cohorts of activities of daily living to bathing,dressing,toileting,indoor transferring,continence,and feeding were selected from the CLHLS database.The sample sizes(people)were 15542,17369,17210,17455,17824,and 17633.By the end of the follow-up in 2018,a total of4,742 people had impaired ability to bathe,3,338 people had impaired ability to dress,3,370 people had impaired ability to go to the toilet,3,015 people had impaired indoor mobility,2,065 people had impaired continence,and 2,360 people had impaired ability to feed.After adjusting the covariates,taking the elderly who participated in balanced leisure activities as a reference,the elderly who participated in more physical activities(HR=0.860,95%CI: 0.801-0.923)had a higher survival rate of bathing ability than those who participated in more sedentary activities(HR=1.129,95%CI:1.049-1.215);the elderly who participated in more physical activities(HR=0.816,95%CI: 0.748-0.890)had a higher survival rate of dressing ability than those who participated in more sedentary activities(HR=1.153,95%CI: 1.059-1.255);the elderly who participated in more physical activities(HR=0.772,95%CI: 0.708-0.841)had a higher survival rate of toileting ability than the elderly who participated in more sedentary activities(HR=1.144,95%CI: 1.051-1.244);the elderly who participated in more physical activities(HR=0.755,95%CI: 0.689--0.828)had a higher survival rate of indoors transferring ability than those who participated in more sedentary activities(HR=1.125,95% CI: 1.030-1.229).In addition,compared with the elderly who participated in balanced leisure activities,only the elderly who participated in more physical activities had a higher survival rate in continence(HR=0.806,95% CI: 0.721-0.902)and feeding(HR=0.762,95% CI: 0.687-0.845),while there was no significant difference in continence(HR=1.091,95% CI: 0.981-1.214)and feeding ability(HR=1.059,95%CI: 0.981-1.214)between those who participated in balanced leisure activities and those who participated in more sedentary activities(P>0.05).(2)The relationship between ADL and NEPAOlder adults who had been surveyed by CLHLS at three follow-up points in2011,2014,and 2018 were included in the CLHLS database from 2011 to 2018.Complete data were obtained for 2,471 people at three follow-up points.The differences in age,education level,marital status,financial sources,physical function limitations,depression status,and sedentary leisure activities in baseline ADL and Non-exercise physical activity(NEPA)were all statistically significant(P<0.05);among them,the differences in gender and exercise status were only statistically significant in ADL(P<0.05),and the differences in residence were only statistically significant in NEPA(P<0.05);the prevalence of diabetes,hypertension,heart disease,and stroke were not statistically significant in ADL and NEPA(P>0.05).In the cross-lagged model(Model 5)that does not consider the mediating effects of cognitive function after controlling covariate factors such as gender and age,there was no statistical significance in ADL → NEPA cross lagged path coefficient(β =-0.010,P >0.05),but the cross-lagged path coefficient of NEPA→ADL(β =-0.072,P <0.001)was statistically significant.The results showed that the ADL and NEPA had a unidirectional causal temporal relationship,and the frequency of NEPA participation in the elderly negatively predicted the ADL scores of the elderly.(3)The mediating role of cognitive functionAfter controlling covariate factors such as gender and age,it is added to the cross-lagged model of mediating variables of cognitive function(Model 6),the path from NEPA in the baseline survey in 2011 to ADL in the follow-up survey in 2018(NEPA 2011→CF2014→ADL2018),NEPA 2011→CF2014(β = 0.058,P <0.001)and CF2014→ADL2018(β =-0.052,P <0.01)were statistically significant.The mediating effect(effect size =-0.003,P < 0.05)of NEPA in the 2011 follow-up survey on ADL in the 2018 follow-up survey was statistically significant through cognitive function in the 2014 follow-up survey,accounting for 9.09% of the total effect.Conclusions:(1)The types of leisure activities of the elderly can affect their activities of daily living.Participating in moderate physical activities is more beneficial to their activities of daily living than other types of leisure activities.Therefore,the elderly participates more in leisure activities,such as housework,gardening,keeping pets and other physical activities,which are of great significance to their healthy old age.(2)Longitudinal cohort studies based on CLHLS have shown that moderately participating in more NEPA can reduce the risk of ADL disability,and participating in NEPA may reduce the risk of ADL disability through cognitive function to some extent.Clarifying the impact of NEPA participation on ADL disability may provide an important basis for the development of policies and intervention programs to promote active participation in NEPA.For example,the optimization of leisure facilities and the management of community activities can delay the process of ADL disability.