| Summary: | Background Along with the advance in the concept of healthy aging, the activities of daily living (ADL) in middle-aged and older Chinese adults has become a research focus. However, factors associated with the impairment of ADL in this group have been assessed in most of available studies while the changes in the process of ADL impairment have been scarcely explored. Objective To assess the prevalence and associated factors of decline in ADL during the aging process of middle-aged and older adults. Methods This study was conducted in March 2021. Data were collected from the four waves (2011, 2013, 2015, and 2018) of China Health and Retirement Longitudinal Study (CHARLS) , involving 11 439 individuals (≥45 years old) with normal baseline ADL followed up during 2011—2013, 2013—2015, or 2015—2018. Panel-data multinomial logit model was used to assess the associations of 13 factors (defined as independent variables, including demographics, health status, resource accessibility, and social psychology) with the decline in ADL (defined as dependent variable) in these people over the follow-up period. Results The numbers of cases of declined ADL over the three follow-up periods (2011—2013, 2013—2015, and 2015—2018) were 1 829 (44.53%) , 1 758 (40.43%) , 1 215 (40.72%) , respectively. Multinomial logit regression analysis indicated that age, gender, place of residence, education level, number of chronic diseases, prevalence of falls, prevalence of perceived pain, use of auxiliary equipment, natural logarithm of personal income per capita, and level of depression were associated with the decline in ADL (P<0.05) . Conclusion The decline in ADL in middle-aged and older Chinese adults may be related to age, education level, number of chronic diseases, auxiliary equipment usage, per capita income, and depression. To reduce the prevalence of declined ADL in this population, we put forward the following recommendations: promoting the construction of a public service system, strengthening chronic disease management in middle-aged and older adults, incentivizing the development of rehabilitation services market, increasing medical subsidies for specific groups, and attaching importance to the mental health of middle-aged and older adults.
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