Age, Education and Depression Among Older Adults: The Mediating Role of Physical Activity

ABSTRACT

Objectives

Past geriatric studies related to the mediating role of physical activity in depression are scarce. This is perhaps the first study to examine the mediating effects of physical activity on the associations between depression and age, and education among older adults.

Methods

Statistical analyses of cross-sectional data from a nationally representative survey on Malaysian older adult health were conducted. Structural equation modeling was used to assess the extent to which physical activity mediated the relationships between depression and age, and education. Associations between variables were explored using multivariable logistic regressions.

Results

Analyses were based on a sample of 3974 older adults (aged ≥60 years). Only 12.2% of older adults had depression. Age was positively associated with the odds of depression. Better educated older adults were less likely to experience depression than less educated older adults. Physical activity fully mediated the association between depression and age, whereas it partially explained the depression-education relationship.

Conclusions

Older age and low educational levels were risk factors for depression, and physical activity was identified as a mediator.

Clinical implications

Older and less-educated older adults should be encouraged to participate in physical activity, and those at risk of depression should be given special attention.

KEYWORDS:

• Age
• depression
• education
• older adults
• physical activity

Clinical Implication

• Findings of the present study imply that promoting physically active lifestyles in the older population, particularly older people aged ≥ 80 may be one of the effective solutions for addressing geriatric depression issues. Intervention measures should be designed to encourage older people to spend more time on physical activity, especially the low-intensity and joint friendly exercises, such as gardening, walking and bicycling.

• Nationwide policies are urged to provide less-educated older adults with insightful information about the important role of physical activity in improving mental health. Public physical activity programs, for example, are suggested to be organized frequently in an effort to raise physical activity awareness in older adults of all educational levels. The Ministry of Health Malaysia has to ensure that all healthcare workers have undergone basic mental health and physical activity related training so that they understand how to motivate older adults to stay physically active.

• Public health administrators could pay special attention to males, widowed/divorced adults, the unemployed, low-income recipients and Sabah/Sarawak natives as they are prone to depression. The mental health status of these cohorts of older adults should be closely monitored.

Acknowledgments

The authors would like to thank the Director General of Health, Malaysia for his permission to use the data from the National Health and Morbidity Survey (NHMS) 2018, and to publish this article.

Disclosure statement

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

Availability of data and material

The data that support the findings of this study are available from the Ministry of Health Malaysia but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the Ministry of Health Malaysia.

Ethics statement

Medical Research and Ethics Committee of the Ministry of Health Malaysia provided ethical approval on 18 January 2018 (NMRR-17-2655–39047).

CRediT authorship contribution statement

Yong Kang Cheah: Conceptualization, Visualization, Methodology, Validation, Formal analysis, Investigation, Writing – original draft, Writing – review & editing. Sharifah Nazeera Syed Anera: Methodology, Writing – review & editing. Mohd Azahadi Omar: Methodology, Writing – review & editing. Noor Hazilah Abd Manaf: Writing – review & editing. Zera Zuryana Idris: Writing – review & editing.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.