Association between living arrangements and cognitive decline in older adults: a nationally representative longitudinal study in China

Abstract Background: Living arrangements are critical for the survival and well-being of older people, especially in China, filial piety culture demands adult children should care for and serve their parents. The study aimed to explore the association between living arrangements and cognitive decline among older people in China. Methods: Participants included 6,074 older adults over 60 years old (49.65% male, mean age 67.2 years [range 60–98]) from four waves (2011-2018) of the China Health and Retirement Longitudinal Study. Two to four assessments were conducted over a follow-up of an average of 5.3 years (range, 2–7). Cognitive function was evaluated in three dimensions: mental status, episodic memory and visuo-construction. Living arrangements were classified as follows: living alone, living with spouse, living with adult children, living with spouse and adult children and living with others. Multilevel models were used to investigate the relationship between living arrangements and cognitive decline, as well as the gender difference. Results: As the main type of living arrangements of the study participants (44.91%), living with spouse was taken as the reference group. Compared to the reference group, living alone (β=-0.126, P<0.001), living with adult children (β=-0.136, P<0.001), living with spouse and adult children (β=-0.040, P<0.05) and living with others (β=-0.155, P<0.05) were all related to a faster rate of cognitive decline. Further, the association between living arrangements and cognitive decline varied by gender. Living alone (β=-0.192, P<0.001) was associated with a faster cognitive decline only in older men. Living with spouse and adult children (β=-0.053, P<0.05) and living with others (β=-0.179, P<0.05) were associated with faster cognitive decline only in older women. Conclusions: This study suggests that living arrangements in older people in China were associated with cognitive decline, and these associations varied by gender. Greater attention to living arrangements might yield practical implications for preserving the cognitive function of the older population.