Examining Relationships Between Activity, Function, and Mental Health in Older Adults

Keywords:

• Activity
• exercise
• function
• geriatrics
• mental health

Dear fellow clinical gerontologists

Activity, physical function, social connection, and mental health are deeply intertwined. In this issue, our contributors examine these relationships from multiple perspectives. Our issue opens with two reviews. The first systematic review evaluates 17 studies conducted during the COVID pandemic with a total of 14,909 participants aged 60–99 years (de Maio Nascimento et al., 2022). Across studies there was a reduction in physical activity during the pandemic, particularly for those age 71+. Although generally speaking older adults were more emotionally resilient than younger adults in response to the pandemic (Sterina et al., 2021), worsening mental health was associated with multiple factors including restrictions in social relationships, loneliness, and poor sleep. A second review considered the practical effects of assistance dogs on mental, physical, and social well-being in 28 studies (Salmon & Pachana, 2022), finding positive effects on functioning and activity and mental health.

Functional difficulties, and in particular falls, can have dramatic negative physical and emotional consequences for older adults. In a study using an intriguing methodology, 47 older adults who had experienced a fall recounted their memory of the fall as well as a “control memory” (Gallouj et al., 2020), finding higher negative emotional valence, visual imagery, and a sense of “traveling back to the time it happened” for the fall memory than the control memory. The authors conclude that memories of falls should be targeted in clinical interventions as they may play a role in generating fear of falling. Relatedly, Ng et al.’s analysis of 2,487 Medicare beneficiaries (B. P. Ng et al., 2020) found that having both a high physiological risk of falling and a high fear of falling was associated with repeated falls. On a more positive note, a randomized trial of older adults with sarcopenia who participated in a 12-week program of walking and resistance exercise (Yuenyongchaiwat et al., 2022) demonstrated improvements in depression and inflammatory cytokines, in the intervention as compared to the control groups.

Several studies in this issue examine longitudinal changes in activity, function, and mood over recent years including the COVID pandemic period. Among 18,099 older participants in the Canadian Longitudinal Study on Aging (CLSA), pre-pandemic levels of multimorbidity were associated with pandemic levels of depression and anxiety, and the associations between multimorbidity and anxiety decreased during the period of the COVID-19 surveys (Wister et al., 2022). Among 3,063, adults age 70+ from the 2019–2021 National Health and Aging Trend Study (NHATS), there were both increased and decreased frequencies of going outside in 2021 as compared to 2020. Decreased frequency was associated with depression/anxiety and other outcomes and was associated with practical factors like COVID concerns and transportation problems (Choi et al., 2023). In an examination of 2,441 weekly online health forms collected from 100 participants in the Collaborative Aging Research Using Technology initiative who were living in the U.S. Pacific Northwest, levels of depressed mood and loneliness increased during the pandemic, and, not surprisingly, travel outside of the home was reduced (Lennon et al., 2022). Results did not differ if the individual was living in a rural or urban context. Another critical aspect of social activity in older adults, often neglected, is sexual activity. In a sample of 190 older adults recruited from a primary care clinic in Thailand, about half were sexually active during the pandemic, but more than half decreased their frequency of sexual activity related to concerns about COVID and social distancing (Burapakiat et al., 2022).

Social support and connection are critical protective factors in depression. In another analysis of Medicare beneficiaries (N = 6,173), 40.8% reported feeling more stressed or anxious during the pandemic which was associated with feeling less socially connected as well as other practical challenges such as difficulties getting home supplies and health care (B. P. Ng et al., 2022). These issues are further illuminated in a study qualitative study of 20 older adults with depression receiving care in their homes during the pandemic (Grohé et al., 2022), who missed social and physical contact, reported feeling disconnected, but also a sense of togetherness with the rest of society. Again, on a more positive note, results of a pilot trial of telephone-based behavioral activation with older adults during the pandemic found that telephone delivery was feasible and revealed within-group decreases in depressive symptoms which were maintained for 6 months after the four-week intervention (Pellas et al., 2022).

Relationships between depression and function are multidirectional as evidenced in a series of multivariate analyses from different regions across the globe included in this issue. Among 3,658 older participants from the China Health and Retirement Longitudinal Study (CHARLS), physical activity was associated with cognitive function and depression, with depressive symptoms mediating the relationship between physical activity and cognitive function subjects (Liu et al., 2022). In a profile analysis of 1,591 French-speaking older adults living in Quebec (Canada), less favorable functional profiles were associated with low physical activity and mood symptoms, among other predictors, with high social support as a protective factor (Vasiliadis et al., 2022). Among 147 older adults living in Nepal, social support moderated the relationship between level of function (measured here on the Karnofsky performance status scale) and depression (Adhikari & McLaren, 2023). Relatedly, among 111 older adults living in Singapore, purpose in life mediated the relationship between level of function (measured here as instrumental activities of daily living) and depression (W. Q. Ng & Yang, 2022). Taken together, these articles demonstrate the intertwined relationship of activity, social connection, functional well-being, and mental health – as well as opportunities for intervention. We thank all the authors for their important contributions.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This material is the result of work supported with resources and the use of facilities at the VA Boston Healthcare System. The contents do not represent the views of the US Department of Veterans Affairs or the United States Government.