Coordinated Care Experience in Late-Life and Cognitive Aging of Older Adults in the United States: A Longitudinal Cohort Study

BACKGROUND: The fragmentation of the US healthcare system imposes a high cognitive burden on older adults. Coordinated Care (CC) is hypothesized to improve patient outcomes, but the relationship between multidimensional CC experiences and cognitive aging remains unclear. We investigated whether experiences across three domains of CC (perceived CC, tangible support, and technical support) are associated with cognitive trajectories and incident cognitive impairment. METHODS: Data were drawn from the Health and Retirement Study (2016-2022), including the 2016 CC module (N = 1321; aged ≥ 50). Baseline CC was assessed via three patient-reported scales: perceived CC (provider communication consistency, 0-20 scale), tangible support (family/professional assistance with medical tasks, 0-11 scale), and technical support (patient portal offered and used, 0-4 scale). Cognitive function was measured biennially (2016-2022) using the 27-point Telephone Interview for Cognitive Status (TICS). Incident cognitive impairment was defined as the first follow-up score of ≤ 11 among those cognitively normal at baseline. Linear mixed-effects models estimated 6-year cognitive trajectories, and Cox proportional hazards models assessed risk of incident impairment. RESULTS: In fully adjusted models, higher perceived CC (β = 0.25, p < 0.05) and technical support (β = 0.22, p < 0.05) were associated with higher baseline cognitive scores. Greater tangible support was associated with lower baseline cognition (β = -0.48, p < 0.001) but also with slower cognitive decline over time (interaction β = 0.005, p < 0.05). Tangible support was associated with higher risk of impairment in unadjusted analyses (HR = 1.26), but this association was not statistically significant after adjustment. CONCLUSIONS AND IMPLICATIONS: Perceived CC and technology use characterized cognitively robust older adults, whereas tangible support identified vulnerable individuals yet was associated with slower cognitive decline. These findings underscore the need for nuanced CC strategies: digital tools engage those aging well, while intensive tangible support may be especially important for those with greater vulnerabilities. These associations are observational and do not establish causality.