Financial decision-making power and mental well-being in older adults: a nationwide longitudinal cohort study in China.

A graded dose-response relationship was observed between financial decision-making power and mental health, with lower decision-making power associated with poorer mental health across all five outcomes.

• Mental health was assessed via five indicators: psychological resilience, subjective well-being, life satisfaction, self-rated health, and loneliness.
• Financial decision-making power was self-reported on a four-point ordinal scale.
• Fixed-effects models were applied to control for time-invariant confounders.
• The study analyzed five waves (2005-2014) of the CLHLS, comprising 23,994 observations from 9,055 adults aged 65 years or older.

Older adults without financial decision-making power showed significantly lower psychological resilience and subjective well-being compared to those with full autonomy.

• Psychological resilience was significantly lower among those without decision-making power (β = -0.31, p < 0.001).
• Subjective well-being was significantly lower among those without decision-making power (β = -0.51, p < 0.001).
• Comparisons were made against older adults with full financial autonomy as the reference group.

Activities of daily living (ADL) mediated between 13.0% and 31.8% of the total effect of financial decision-making power on mental health outcomes.

• Mediation analyses were conducted using a bootstrapping approach with 500 repetitions.
• ADL mediation ranged from 13.0% to 31.8% of the total effect across different mental health outcomes.
• The strongest mediation by ADL was observed for loneliness.
• Inverse probability weighting was used to address attrition bias.

Leisure activities mediated between 10.0% and 34.2% of the total effect of financial decision-making power on mental health outcomes.

• Leisure activity mediation ranged from 10.0% to 34.2% of the total effect across mental health outcomes.
• The strongest mediation by leisure activities was also observed for loneliness.
• Both ADL and leisure engagement were identified as partial mediators of the financial decision-making power–mental health relationship.

Among functionally independent participants at baseline, functional capacity exhibited dual mediating roles: a positive pathway for self-rated health and a suppression effect for loneliness.

• This dual mediation finding was observed specifically in the subsample who were functionally independent at baseline.
• Functional capacity acted as a positive mediator for self-rated health outcomes.
• Functional capacity acted as a suppressor for loneliness outcomes.
• These contrasting roles suggest functional capacity operates through different mechanisms depending on the mental health dimension examined.

The protective effects of financial decision-making power on mental health were more pronounced among economically disadvantaged, financially dependent, female, and younger-old adults.

• Heterogeneity analyses revealed differential effects across subgroups.
• Four subgroups showed more pronounced benefits: economically disadvantaged, financially dependent, female, and younger-old adults.
• Protective effects were described as 'partially offsetting vulnerabilities in these populations.'
• These findings suggest differential vulnerability and potential for targeted interventions.

The study used a nationwide longitudinal cohort design with five waves of data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) spanning 2005 to 2014.

• The sample comprised 23,994 observations from 9,055 adults aged 65 years or older.
• Five waves of data were collected between 2005 and 2014.
• Fixed-effects models were used to control for time-invariant confounders.
• Inverse probability weighting was applied to address attrition bias.