High-Frequency Functional Trajectories Predict Depressive Worsening in Singapore’s Community-Dwelling Older Adults

<b>Background/Objectives</b>: Functional difficulty and depression often coexist in older adults, yet local Singapore-based research often lacks detailed temporal resolution due to heterogeneity in ageing. This study employs non-parametric, data-driven longitudinal clustering to analyse functional trajectories and their association with depression, using high-frequency data to pinpoint key intervention periods. <b>Methods</b>: Data were drawn from 4273 community-dwelling older adults from Singapore Life Panel<sup>®</sup> (2020-2024). Participants completed quarterly self-reported assessments of ADL, IADL and depressive symptoms (8-item CES-D). We employed k-means longitudinal clustering (kml) to identify functional trajectory groups and Cox regression to evaluate the hazard of increased depression (≥5-point increase in CES-D). <b>Results</b>: Three distinct trajectories emerged for both ADL and IADL (Stable, Medium increase in difficulty, High increase in difficulty). In fully adjusted Cox models, Medium and High clusters had higher hazard ratios for increased depression than Stable (ADL: HR 1.71 and 2.37; IADL: HR 1.60 and 2.20). Median time-to-event was not reached in the Stable group and occurred earlier in Medium/High clusters (ADL: 3.25 years and 1.75 years; IADL: 4.0 years and 2.1 years). The High cluster, comprising older and socioeconomically disadvantaged individuals, exhibited worse baseline health and psychosocial factor scores. Depression scores escalated in the Medium and High groups. <b>Conclusions</b>: Rapid functional difficulty acts as a precursor to worsening depressive symptoms. Routine monitoring of functional trajectories offers a strategic window for proactive mental health interventions in at-risk older adults.

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Publication Details

Journal
Healthcare
Published
2026-03-02
DOI
https://doi.org/10.3390/healthcare14050629
Primary Topic
Dementia and Cognitive Impairment Research
Type
article
Field-Weighted Citation Impact
0.00

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article

High-Frequency Functional Trajectories Predict Depressive Worsening in Singapore’s Community-Dwelling Older Adults

Yi Wen Tan, Paulin Straughan, Kaung H. T. Salai, Grace Cheong
Healthcare
Dementia and Cognitive Impairment Research
article

High-Frequency Functional Trajectories Predict Depressive Worsening in Singapore’s Community-Dwelling Older Adults

Yi Wen Tan, Paulin Straughan, Kaung H. T. Salai, Grace Cheong
article en

Abstract

<b>Background/Objectives</b>: Functional difficulty and depression often coexist in older adults, yet local Singapore-based research often lacks detailed temporal resolution due to heterogeneity in ageing. This study employs non-parametric, data-driven longitudinal clustering to analyse functional trajectories and their association with depression, using high-frequency data to pinpoint key intervention periods. <b>Methods</b>: Data were drawn from 4273 community-dwelling older adults from Singapore Life Panel<sup>®</sup> (2020-2024). Participants completed quarterly self-reported assessments of ADL, IADL and depressive symptoms (8-item CES-D). We employed k-means longitudinal clustering (kml) to identify functional trajectory groups and Cox regression to evaluate the hazard of increased depression (≥5-point increase in CES-D). <b>Results</b>: Three distinct trajectories emerged for both ADL and IADL (Stable, Medium increase in difficulty, High increase in difficulty). In fully adjusted Cox models, Medium and High clusters had higher hazard ratios for increased depression than Stable (ADL: HR 1.71 and 2.37; IADL: HR 1.60 and 2.20). Median time-to-event was not reached in the Stable group and occurred earlier in Medium/High clusters (ADL: 3.25 years and 1.75 years; IADL: 4.0 years and 2.1 years). The High cluster, comprising older and socioeconomically disadvantaged individuals, exhibited worse baseline health and psychosocial factor scores. Depression scores escalated in the Medium and High groups. <b>Conclusions</b>: Rapid functional difficulty acts as a precursor to worsening depressive symptoms. Routine monitoring of functional trajectories offers a strategic window for proactive mental health interventions in at-risk older adults.

HealthcareVol. 14(5)
Singapore Management University (SG)
Ministry of Education - Singapore, Ministry of Education, India
Openalex Percentile: Top 44%
Dementia and Cognitive Impairment Research
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