Association between disability and cognitive function in older Chinese people: a moderated mediation of social relationships and depressive symptoms

Abstract

Objective: Many previous studies have found that disability leads to cognitive impairment, and in order to better understand the underlying mechanisms between disability and cognitive impairment, the present study aimed to investigate the moderating role of social relationships, including their role as mediators between disability and cognitive impairment in depressive symptoms.

Study design: This is a cross-sectional study.

Methods: A total of 5,699 Chinese older adults from the 2018 China Longitudinal Healthy Longevity Survey (CLHLS) were included in this study, and PROCESS macro was used to perform simple mediator and moderator mediator analyses, which were used to analyze the relationship between depressive symptoms and social relationships between disability and cognitive impairment.

Results: The results of this study showed significant correlations between disability, cognitive impairment, depressive symptoms, and social relationships, and that depressive symptoms mediated the relationship between disability and cognitive functioning [B = -0.232; 95% CI: (-0.304, -0.164)], and that social relationships mediated disability and cognitive functioning through pathway a (Disability-Depressive Symptoms) [B = 0.190; 95% CI: (0.020, 0.036)], path b (depressive symptoms-cognitive impairment) [B = 0.029; 95% CI: (0.015, 0.042)], and path c' (incapacitation-cognitive impairment) [B = 0.492; 95% CI: (0.298, 0.685)] to modulate the effect of incapacitation on cognitive impairment. In addition, social activities and social networks moderated the mediation model directly or indirectly, whereas social support moderated only the direct effect.

Conclusion: This study explains the intrinsic link between incapacitation and cognitive impairment in Chinese older adults, and that social relationships and depressive symptoms can directly or indirectly modulate the effects between them. This provides a basis for healthcare professionals to be able to better develop interventions that can be used to improve the level of cognitive functioning and mental health of older adults.

Keywords: cognitive impairment; depressive symptoms; disability; mediation; moderate; social relationships.

Figure 1

Moderation of the social relationship model as a mediating model of depression between disability and cognitive function (Andrew Hayes’ moderate-mediation model 59).

Figure 2

Flow chart of the selection of study participants.

Figure 3

The final moderated mediation model: social relationships as moderator of the mediation model of depression between disability and cognitive function (Andrew Hayes’s mediation-moderation Model 15, *p < 0.05; **p < 0.01; ***p < 0.001). The moderated mediation model was controlled for covariates (age, gender, education, place of residence, exercise, financial support).

Figure 4

The final moderated mediation model: social activities and social networks as moderators of the mediation model of depression between disability and cognitive function (Andrew Hayes’s mediation-moderation Model 76, *p < 0.05; **p < 0.01; ***p < 0.001). The moderated mediation model was controlled for covariates (age, gender, education, place of residence, exercise, financial support).

Figure 5

The simple plot of path (A,B) indicating the relationship between disability (0 = non-disabled,1 = disabled), depressive symptoms, and cognitive impairment among different levels of social relationships.

Figure 6

The simple plot of path (A–C) indicating the relationship between disability (0 = non-disabled,1 = disabled), depressive symptoms, and cognitive impairment among different levels of social activities and social networks group.