Background <p>This study aims to investigate the relationship between cognitive impairment, depressive symptoms, and Activities of Daily Living (ADL)/ Instrumental Activities of Daily Living (IADL) dependency among older people living in rural areas.</p> Methods <p>We analyzed data from the China Health and Aging Longitudinal Study 2020, focusing on the rural older adults over 60. We identified four groups and constructed three regression models (models 1–3) to investigate the relationship between cognitive impairment or depression and dependency.</p> Results <p>Based on a logistic regression model, older adults living in rural areas face a sequentially increased risk of dependence on ADL if they in group 2 (OR = 1.33, 95% CI = 1.09–1.63), group 3 (OR = 1.76, 95% CI = 1.43–2.17), or group 4 (OR = 2.38, 95% CI = 1.95–2.91), when compared to a reference group 1. Group 2 (OR = 2.44, 95% CI = 2.03 to 2.93) was more likely to be at risk of IADL dependence than Group 3 (OR = 1.99, 95% CI = 1.64 to 2.43).</p> Conclusions <p>This study highlights the substantial impact of depression and cognitive impairment on ADL/IADL dependence among rural older adults, with an especially heightened risk when both disorders are present simultaneously. Moreover, factors such as gender, age, inpatient services, outpatient services, and self-rated health are strongly associated with functional dependence in this population.</p>