Caregiving Models and Cognitive Decline in Middle-Aged and Older Adults with Limitations in Activities of Daily Living: A CHARLS Cohort Study (2011-2020)

INTRODUCTION: Limitations in activities of daily living represent a crucial risk factor for cognitive decline, while the role of caregiving models in this process remains unclearly elucidated. To examine the correlation between different caregiving models and cognitive decline of people aged 45 and above with basic activity of daily living (BADL)/instrumental activities of daily living (IADL) limitations. METHODS: Data were derived from the China Health and Retirement Longitudinal Study database covering the period 2011-2020. Using multiple linear regression models and linear mixed effect models (LMM), the association between different nursing models and cognitive function trajectories was systematically evaluated, and subgroup analyses were conducted to test the robustness and heterogeneity of the results. RESULTS: Multiple regression analysis indicated that spousal care was negatively associated with Mini-Mental State Examination (MMES) scores (OR = 0.68, 95% CI: 0.12-1.24, p = 0.017), whereas care provided by children, other relatives, and hired caregivers notably improved MMSE scores (p < 0.05), with hired care yielding the greatest improvement (OR = 4.61, 95% CI: 2.08-7.14, p < 0.001). The LMM further revealed that, compared to no care, all other care types were substantially related to the rate of change in MMSE scores over time. Subgroup analysis demonstrated pronounced interactions in sex and chronic disease subgroups (P for interaction <0.05). CONCLUSION: This work provides empirical evidence for optimizing long-term care services, highlighting the importance of integrating professional care support to delay cognitive decline among individuals aged 45 and older with BADL/IADL limitations.