Relation of Participation in Productive Activities with Incident Disability Among Chinese Older Adults

Background and purpose: Maintaining functional health among older adults is a major public health concern given that declining in physical functioning has negative impact on quality of life and increases cost of care. Disability in activities of daily living is related to loss of independence, an increased risk of comorbidity, nursing home admissions and mortality. It is therefore necessary to identify modifiable factors associated with the earliest onset of disability in order to design effective intervention to delay or avoid incident disability. Research has demonstrated the positive effect of productive engagement on older people’s physical health. Participation in productive activities is one type of significant but not yet adequately examined factor that affect disability onset. The purpose of this study is to examines the relationship between productive activity participation and the incidence of ADL disability over time.

Methods: Data came from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) (2002-2011). The at-risk sample consisted of 10,632 participants aged 60 or older who were free of ADL disability in 2002. A multi-category time-varying variable was used to capture three potential health outcomes: (1) persistently free of any ADL disability between waves, (2) onset of any ADL disability, and (3) death between waves. Attrition (i.e. lost to follow-up) was also included as a competing outcome.  Productive activities were defined as engaging in paid work or providing assistance to family. Multilevel multinomial logistic regression models that account for clustering of observations within a subject over time were employed for the study.

Results:The results show that providing assistance to family is significantly associated with reduced risk of ADL onset and death over time, controlling for individual socio-demographic characteristics, chronic diseases conditions, and cognitive health status. While engaging in paid work is not significantly associated with incident disability or death.

Conclusions and implications:Results suggest that encouraging participation in productive activities, especially providing assistance to family, may help older Chinese adults delay the onset of disability. Practitioners or policy makers could use this evidence to develop more family-oriented productive activities for Chinese older adults.