Cabib Ignacio, Olea-Durán Bastián, Villalobos Dintrans Pablo, Browne Salas Jorge
Instituto de Sociología & Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile.
Centro UC Estudios de Vejez y Envejecimiento, Pontificia Universidad Católica de Chile, Santiago, Chile.
Aging Ment Health. 2023 Jul-Aug;27(8):1534-1543. doi: 10.1080/13607863.2023.2188170. Epub 2023 Mar 12.
Despite the advances in understanding the complex association between functional abilities and mental health in old age, studies have overlooked two important aspects. First, traditionally, research has employed cross-sectional designs, measuring limitations at a single time point. Second, most gerontological studies on this field have been conducted before the COVID-19 pandemic onset. This study aims to explore the association between diverse long-term functional ability trajectories across late adulthood and old age, and older people's mental health in Chile, before and after the COVID-19 pandemic onset.
We use data from the population-representative and longitudinal 'Chilean Social Protection Survey', sequence analysis to reconstruct functional ability trajectory types from 2004 to 2018, and bivariate and multivariate analyses to measure their association with depressive symptoms in early 2020 ( = 891) and late 2020 ( = 672). We analyzed four age groups defined by their age at baseline (2004): people aged 46-50, 51-55, 56-60, and 61-65.
Our findings indicate that erratic or equivocal patterns of functional limitations across time (with people transiting back and forth between low and high levels of limitations) show the worst mental health outcomes, both before and after the pandemic onset. Prevalence of people with depression increased after the COVID-19 onset in most groups, being particularly high among those with previous equivocal functional ability trajectories.
The relationship between functional ability trajectories and mental health calls for a new paradigm, moving away from age as the main policy guide, and highlighting the need to adopt strategies to improve population-level functional status as an efficient policy to address the challenges of population aging.
尽管在理解老年人功能能力与心理健康之间的复杂关联方面取得了进展，但研究忽略了两个重要方面。首先，传统上，研究采用横断面设计，在单个时间点测量功能受限情况。其次，该领域的大多数老年学研究都是在新冠疫情爆发之前进行的。本研究旨在探讨成年晚期和老年期不同的长期功能能力轨迹与智利老年人在新冠疫情爆发前后心理健康之间的关联。
我们使用具有人口代表性的纵向“智利社会保护调查”数据，通过序列分析重建2004年至2018年的功能能力轨迹类型，并进行双变量和多变量分析，以测量它们与2020年初（n = 891）和2020年末（n = 672）抑郁症状的关联。我们分析了根据基线年龄（2004年）定义的四个年龄组：46 - 50岁、51 - 55岁、56 - 60岁和61 - 65岁的人群。
我们的研究结果表明，随着时间推移功能受限呈现不稳定或不明确模式（人们在低水平和高水平功能受限之间来回转换）的人群，在疫情爆发前后心理健康状况最差。在大多数组中，新冠疫情爆发后抑郁症患者的患病率有所增加，在之前功能能力轨迹不明确的人群中尤其高。
功能能力轨迹与心理健康之间的关系需要一种新的范式，摒弃将年龄作为主要政策指导的做法，并强调需要采取策略改善人群层面的功能状态，作为应对人口老龄化挑战的有效政策。
