Association of intergenerational relationships with cognitive impairment among Chinese adults 80 years of age or older: prospective cohort study
Background: The oldest-old (aged 80 or older) are the most rapidly growing age group, and they are more likely to suffer from cognitive impairment, leading to severe medical and economic burdens. The influence of intergenerational relationships on cognition among Chinese oldest-old adults is not clear. We aim to examine the association of intergenerational relationships with cognitive impairment among Chinese adults aged 80 or older.
Methods: This was a prospective cohort study, and data were obtained from the Chinese Longitudinal Healthy Longevity Survey, 14,180 participants aged 80 or older with at least one follow-up survey from 1998 to 2018. Cognitive impairment was assessed by the Chinese version of Mini Mental State Examination, and intergenerational relationships were assessed by getting main financial support from children, living with children or often being visited by children, and doing housework or childcare. We used time-varying Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of associations between intergenerational relationships and cognitive impairment.
Results: We identified 5443 incident cognitive impairments in the 24-cut-off MMSE cohort and 4778 in the 18-cut-off MMSE cohort between 1998 and 2018. After adjusting for a wide range of confounders, the HR was 2.50 (95% CI: 2.31, 2.72) in the old who received main financial support from children, compared with those who did not. The HR was 0.89 (95% CI: 0.83, 0.95) in the oldest-old who did housework or childcare, compared with those who did not. However, there were no significant associations between older adults' cognitive impairments and whether they were living with or often visited by their children. Our findings were consistent in two different MMSE cut-off values (24 vs. 18) for cognitive impairment.
Conclusions: Sharing housework or childcare for children showed a protective effect on older adults' cognitive function, whereas having children provide primary financial support could increase the risk for cognitive impairments. Our findings suggest that governments and children should pay more attention to older adults whose main financial sources from their children. Children can arrange some easy tasks for adults 80 years of age or older to prevent cognitive impairments.