# Associations between modifiable risk factors and limitation in activities of daily living among individuals aged ≥ 45 years: Evidence from the China health and retirement longitudinal study (CHARLS)

## TL;DR

This study finds that exercise, good sleep, and cognitive health reduce the risk of daily living limitations in older Chinese adults.

## Contribution

The study identifies specific modifiable risk factors for ADL limitations in older adults using national data from CHARLS.

## Key findings

- Exercise and adequate sleep significantly reduce the risk of BADL and IADL limitations.
- Depression and chronic diseases increase the risk of ADL impairment.
- The impact of modifiable risk factors on ADL becomes more pronounced with increasing age.

## Abstract

With aging populations, a growing number of older people are subjected to limitations in activities of daily living (ADL), causing a tremendous burden and challenges to patients' quality of life and policymakers. Investigating modifiable risk factors for ADL remains an important project to help lower its risk. This study aimed to explore associations between the modifiable risk factors and ADL using national-scale data from the China Health and Retirement Longitudinal Study (CHARLS).

Data were downloaded from CHARLS 2020, a population-based longitudinal survey. We included modifiable risk variables and ADL index, i.e., basic ADL (BALD) and instrumental ADL (IADL). Afterward, variables were included in the logistic regression model construction. Also, propensity score matching (PSM) was employed to validate the findings. Finally, we tried to discuss the associations between different age groups.

A total of 12,248 participants were included in this study, comprising 5799 women (47.35%) and 6449 men (52.65%). The median age was 62 (55–69) years. Among the participants, 2055 (16.78%) had limitations in BADL, and 1838 (15.01%) had limitations in IADL. Logistic regression demonstrated that exercise significantly reduced the risk of BADL and IADL impairment (BADL: OR = 0.70, 95% CI: 0.59–0.83; IADL: OR = 0.65, 95% CI: 0.55–0.78; P < 0.001). Similarly, better cognitive ability was associated with a lower risk of impairment (BADL: OR = 0.68, 95% CI: 0.61–0.75; IADL: OR = 0.60, 95% CI: 0.54–0.67; P < 0.001). Adequate sleep duration (6–8 hours) also significantly reduced the likelihood of functional decline (BADL: OR = 0.49, 95% CI: 0.45–0.55; IADL: OR = 0.48, 95% CI: 0.43–0.53; P < 0.001). In contrast, depression symptoms and chronic diseases significantly increased the risk of both BADL and IADL impairment. Besides, PSM showed similar findings, and the risk of ADL increased with age.

Modifiable risk factors, such as exercise, cognitive ability, depression symptoms, chronic diseases, social activities, and sleeping duration, were significantly associated with ADL. Besides, as age increases, the impact of various modifiable risk factors on ADL becomes more evident, emphasizing special care for older populations and offering scientific ideas for policymakers.