Abstract
AIM: To investigate the effects of depression on patient activation and summer heat adaptation, considering important contributory factors in older adults with increased cardiovascular health concerns on extremely hot days. DESIGN: Cross-sectional study adhering to the STROBE guidelines. METHODS: Between July and August 2020, a questionnaire survey was administered to 245 older adults at increased risk of cardiovascular diseases in rural areas. Data were collected utilising validated and reliable tools to assess patient activation, depression, summer heat adaptation, frailty, physical activity and other health-related characteristics. Hierarchical regression, mediation and path analyses were conducted to examine the association between activation, depression and summer heat adaptation, while controlling for covariates. RESULTS: Most participants exhibited the lowest level of activation (75.1%) and a low/moderate level of summer heat adaptation (80.4%). Depression negatively affected activation (β = -0.247), while its indirect effect on patient activation through summer heat adaptation was insignificant (p > 0.05). Education (β = 0.380) and a family history of cardiovascular disease (β = 0.121) positively influenced activation, while alcohol consumption had a negative influence (β = -0.219). When integrating the influence of these three contributory factors, the associative relationship between depression and activation through summer heat adaptation demonstrated a good model fit (chi-square = 8.944, p > 0.05; comparative fit index = 0.987; root mean square error of approximation = 0.045). CONCLUSION: Improving older adults' activation for self-managing chronic conditions in summer requires tackling depression, enhancing heat adaptation and addressing concerns related to lack of education and alcohol consumption. PATIENT OR PUBLIC CONTRIBUTION: Patients with cardiovascular diseases were involved in piloting the questionnaire and provided examples to address older adults' concerns related to self-management and heat adaptation.