Publication Type
Journal Article
Version
publishedVersion
Publication Date
3-2026
Abstract
Background/Objectives: 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. Methods: Data were drawn from 4273 community-dwelling older adults from Singapore Life Panel® (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). Results: 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. Conclusions: 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.
Keywords
functional difficulty, depression, k-means longitudinal clustering, ageing population, superaged societies
Discipline
Asian Studies | Gerontology | Mental and Social Health
Research Areas
Sociology
Publication
Healthcare
Volume
14
Issue
5
First Page
1
Last Page
18
ISSN
2227-9032
Identifier
10.3390/healthcare14050629
Publisher
MDPI
Embargo Period
3-26-2026
Citation
SALAI, Kaung Htet Tun; TAN, Yi Wen; CHEONG, Grace; and STRAUGHAN, Paulin T..
High-frequency functional trajectories predict depressive worsening in Singapore's community-dwelling older adults. (2026). Healthcare. 14, (5), 1-18.
Available at: https://ink.library.smu.edu.sg/rosa_publications/7
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Additional URL
https://doi.org/10.3390/healthcare14050629