Poverty, Functional Limitations, and Depression Among Older Adults: Do Community Services Make a Difference?

Background and Purpose: As part of encouraging aging-in-place, community-based services for older adults have expanded in recent decades. These community-based services include personal and home care, case management, meal service, and transportation services that help older adults successfully age in communities. It has been found that functional limitations and poverty are risk factors that could raise depressive symptoms in old age. Since community services increase chances to have more social interactions and elders’ perceived sources of support, they could positively affect their psychological well-being. These beneficial effects may be stronger among vulnerable elders such as those with functional limitations and in poverty. This study aims to investigate to what extent and how community-based service influence depressive symptoms among vulnerable elders.

Methods: Data and Sample - The data came from the 2012 Health and Retirement Study, which is a nationally representative panel survey of individuals 51 years or older. Our sample was restricted to respondents who participated in the special questionnaire about community service utilization (N=1,710).

Measures - Depressive symptoms was based on an eight-item version of the Center for Epidemiologic Studies Depression scale. Community service was measured whether or not receiving at least one of the services such as congregate meal program, home delivered meals, home services, transportation services, and case management services. Functional limitation was measured based on a sum of limitations in performing five activities of daily living and five instrumental activities of daily livings. Poverty indicated a lowest quartile income group among the sample.

Analyses- A series of OLS regressions were used to examine the associations between functional limitations/poverty and depressive symptoms among elders, and how community services moderate these associations.

Results: Both functional limitations (Coef.=0.423, p<.001) and poverty (Coef.=0.243, p<.05) were found to be risk factors that were significantly associated a greater number of depressive symptoms in old age even after controlling for other sociodemographic attributes. The main findings of this study were significant moderating effects of the community services on the associations between functional limitation/poverty and depressive symptoms.  Community services reduced negative effects of functional limitations (Coef.=-0.643, p<.05) and poverty (Coef.=-0.236, p<.001) on depressive symptoms.

Conclusions and Implications: This study demonstrates the beneficial effects of community services on depressive symptoms among older adults with functional limitations or in poverty. It provides implications for the importance of community services for aging-in-place policy, particularly for vulnerable populations. Further study needs to investigate more detailed mechanism to what extent and how specific types of community services positively influence psychological well-being and mental health among older people.