Functional Limitation and Psychological Well-Being Among Chinese Older Adults: Does Participation in Productive Activities Make a Difference?

Background and Purpose:Aging is often accompanied by a decline in functional performance. Functional limitation is usually a risk factor for a poorer psychological well-being among older adults. However, the “disability paradox” theme implies that the association between functional limitation and psychological well-being may not be as straightforward as it appears. Meanwhile, research has demonstrated the positive effect of productive activity participation on older adults’ psychological well-being. The goal of this study is two folds: (1) to examine the relationship between functional limitation and psychological well-being over time, (2) to examine how the strength of the association between functional limitation and psychological well-being varies by productive activity participation.

Methods:Data came from 2002 to 2011 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Study sample consisted of 15,324 participants aged 60 or older in 2002. Functional Limitation was measured using activities of daily living (ADLs) and instrumental activities of daily living (IADLs). All ADL and IADL items were rated on a 3-point scale: 1=no difficulty at all, 2=some difficulties, and 3=unable to perform the task. A sum score was calculated, with higher scores indicating more limited functional ability. Psychological well-being was measured based on seven items that assessed optimism, conscientiousness, self-determination, happiness, self-esteem, pessimism, and loneliness, with responses ranging from “always (1)” to never (5)”. Negative feelings items were reverse coded so that the higher the score, the more positive the psychological well-being. Productive activities were defined as engaging in paid work or providing assistance to family. Multilevel mixed-effects generalized linear models were employed for this study. Sociodemographics, chronical diseases conditions, and cognitive health status were served as controls.

Results:Results show that functional decline was associated with poorer psychological well-being during a 9-year follow-up period. Participation in productive activities of providing assistance to family buffered the negative effect of functional decline on psychological well-being. Older adults who provided assistance to family had a slower rate of psychological well-being decline over time as compared with those who had a similar functional limitation level but never provided assistance to family. However, engaging in paid work didn’t show the buffering effect on the relationship between functional decline and psychological well-being for Chinese older adults.    

Conclusions and Implications: Results from this study demonstrated that there was a buffering effect of productive activity (esp. providing assistance to family) on the impact of functional limitation on psychological well-being. Encouraging participation in productive activities could be a viable way to help older Chinese adults remain relatively good psychological well-being. This finding has implications for policies or programs that seek to promote productive aging among Chinese older adults. Practitioners or policy makers could use this evidence to develop more family-oriented productive activities for Chinese older adults.