Cohabitation and Depression in Older Adults: When Disability and Transportation Barriers Intersect

Background/Purpose:

Transportation is a key social determinant of mental health, especially for older adults who increasingly rely on their neighborhoods and transportation. As aging-related health declines heighten the risk of disability, dependence on communities and co-living partners becomes more critical. However, research on the intersection of transportation barriers, disability, and cohabitation remains scarce. This study explores how these factors interact to influence depression in older adults, focusing on person-environment interactions and how individuals adapt to stress and adversity.

Methods: Data came from the 2022 and 2023 National Health Interview Survey (NHIS). Using the Social Security Administration’s definition of advanced age, we identified older adults as those over the age of 55, resulting in a total of 17,575 individuals. We measured disability using a dichotomous variable provided by the NHIS based on the Washington Group Short Set on Functioning (WG-SS). We assessed transport barriers with another dichotomous variable indicating whether an older adult lacked reliable transportation for daily living in the past 12 months. The information of partner co-residence came from the combination of marital status and whether an older adult was living with the partner. Depression was measured by the frequency of feeling depressed: “never”, “monthly-to-yearly”, and “weekly-to-daily”. Descriptive, bivariate, and ordinal regression with moderation analyses were conducted to examine the association. All the analyses counted for survey weights and the complex sample design.

Results: After adjusting for sociodemographic and health-related variables, we first analyzed the relationship between disability, transportation barriers, partner co-residence, and depression without considering moderation effects. Individuals with disabilities or transportation barriers had a higher frequency of depression (O.R. = 1.89, p < .0001; O.R. = 1.42, p < .0001, respectively), whereas those living with a partner had a lower frequency of depression (O.R. = 0.76, p < .0001). When moderation effects were considered, partner co-residence emerged as a protective factor against the impact of transportation barriers on depression, but only among older adults without disabilities (O.R. = 0.95, p = 0.732). Among older adults with disabilities, transportation barriers significantly increased their odds of experiencing depression (O.R. = 2.93, p < .0001). Moreover, partner co-residence did not reduce depression among those facing both disabilities and transportation barriers. In fact, older adults with both disabilities and transportation barriers who lived with their partner were the most likely to experience depression (O.R. = 5.52, p < .0001).

Implications:

These findings reveal that while cohabitation with a partner could buffer the effects of transportation barriers on depression among non-disabled older adults, it does not offer the same protection for those with disabilities. In fact, disabled older adults facing transportation challenges are more likely to experience depression when living with a partner, possibly due to increased feelings of dependence or being a burden. Tailored mental health interventions must address the unique psychological and mobility-related needs of disabled older adults. Future research should further explore the role of environmental factors and perceived autonomy in shaping these outcomes.