Prevalence and factors influencing disability and cognitive impairment among empty nesters and non-empty nesters in Guangdong, China: a cross-sectional study

Abstract

Background: Disability and cognitive impairment affect the physical and mental health of older adult individuals and also impose a heavy burden on families and society. As a threat to their health, the growing trend of empty nesting among older adult individuals is attracting widespread attention.

Objective: To investigate the status of disability and cognitive impairment among empty nesters and non-empty nesters in Guangdong Province and to analyze the differences in their influencing factors to provide a scientific basis for the prevention and control of disability among empty nesters and non-empty nesters.

Methods: Using the stratified random cluster sampling method, we recruited 5,603 individuals older adults 60 years and older from 21 cities in Guangdong Province in southern China, comprising 1,512 empty nesters and 4,091 non-empty nesters. Physical function and cognitive impairment were assessed with the ability to perform basic activities of daily living (BADLs) and scores on the Mini-Mental State Examination (MMSE). Binary logistic regression was performed to analyze the risk factors in the two groups.

Results: The prevalence of disability and cognitive impairment among empty nesters was significantly higher than that in non-empty nesters (40.15% vs. 35.74, 27.51% vs. 23.52%, respectively). Common influencing factors for the occurrence of disability in empty nesters and non-empty nesters were as follows. Binary logistic regression showed that the average monthly household income of empty nesters was 2000-400 RMB (OR: 1.476, 95% CI 1.019, 2.138) and for non-empty nesters was 2000-400 RMB (OR: 1.353, 95% CI 1.048, 1.747). Many study subjects took more than four types of medications (empty nesters: OR: 3.166, 95% CI 1.940, 5.169; non-empty nesters: OR: 2.660, 95% CI 1.957, 3.615). Both populations reported family support (empty nesters: OR: 1.487, 95% CI 1.064, 2.077 and non-empty nesters: OR: 1.341, 95% CI 1.106, 1.626), depression (empty nesters: OR: 1.710, 95% CI 1.104, 2.471 and non-empty nesters: OR: 1.990, 95% CI 1.524, 2.599), and anxiety (yes: OR: 1.652, 95% CI 1.104, 2.471), which was an influential factor specific to the occurrence of disability in empty nesters (p < 0.05). Education level, residence, and depression among empty nesters (OR: 3.111, 95% CI 2.059, 4.701) and non-empty nesters (OR: 1.892, 95% CI 1.461, 2.451) were common influencing factors for the occurrence of cognitive impairment in both groups (p < 0.05). Category 1 medications were an influential factor specific to cognitive impairment among empty nesters (OR: 1.564, 95% CI 1.072, 2.282; p < 0.05); and coronary heart disease was an influencing factor specific to cognitive impairment among non-empty nesters (OR: 1.319, 95% CI 1.046, 1.663; p < 0.05).

Conclusion: The study indicated that empty nesters had a higher prevalence of disability and cognitive impairment than non-empty nesters. The influencing factors were different between empty nesters and non-empty nesters. Low and middle incomes, multiple medication use, family support, and depression were the common influencing factors for the occurrence of disability among empty nesters and non-empty nesters, while anxiety was the unique influencing factor for disability among empty nesters. Literacy level, place of residence, and depression were the common influencing factors for cognitive impairment among empty nesters and non-empty nesters. Multiple medications were an influencing factor specific to cognitive impairment among empty nesters. Coronary heart disease was an influencing factor specific to cognitive impairment in non-empty nesters. Therefore, when intervening in older adults individuals with disability and cognitive impairment, different measures should be taken according to whether they are empty nesters or not.

Keywords: cognitive impairment; disability; empty nest; older adults; root cause analysis.