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Background <p>The accelerating global ageing phenomenon has given rise to a growing concern regarding cognitive decline in older adults. Research shows that spouse health is closely linked to individual well-being, as the physical and emotional health of one partner significantly affects the other. Although the connection between spousal health and older adults’ cognitive function has been recognized, there is still limited research on this specific impact. This study explores how spousal health is linked to cognitive function in older adults by investigating frailty as a mediator and activity engagement as a moderator.</p> Methods <p>This study utilized data from the 2017–2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), which included a sample of 4,652 Married older adults, all aged 65 and above, living with their spouses. Cognitive function was evaluated using the Mini Mental State Examination (MMSE), frailty was measured with a frailty index, and activity engagement was gauged through various activity measures. By using mediation and moderated mediation analyses via the PROCESS macro in SPSS.</p> Results <p>Among the 4,652 participants, 209 (4.49%) had cognitive impairment. Higher spouse health scores (indicating poorer spouse health) were associated with lower cognitive function and lower activity engagement (<i>p</i> &lt; 0.001), and positively associated with frailty (<i>p</i> &lt; 0.001). The frailty index was also negatively associated with cognitive function (<i>p</i> &lt; 0.001). Mediation analysis showed that frailty significantly mediated the association between spousal health and cognitive function (<i>β</i> = -0.071, SE = 0.011, 95% CI: -0.094 ~ -0.050), but direct effects were not significant. In moderated mediation analysis, activity engagement moderated the association between frailty and cognitive function, with lower participation amplifying the negative impact (low: <i>β</i> = -0.064; high: <i>β</i> = -0.051; <i>p</i> &lt; 0.05).</p> Conclusion <p>This study shows a significant association between spousal health and cognitive function among older adults, with frailty serving as a fully mediator in this association. Crucially, activity engagement is associated with a weaker impact of frailty on cognitive abilities, with greater involvement linked to less pronounced cognitive decline. These findings emphasize the dual protective roles of a spouse’s health and activity engagement in sustaining cognitive health.</p>

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Association between spouse health and cognitive function in older Chinese adults: a moderated mediation of frailty and activity engagement

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月25日

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  • Junhao Huo,
  • Yuyan Ding,
  • Jiandong Bai,
  • Yali Wang,
  • Jinxin Zhang,
  • Shuangshuang Yang,
  • Lili Cui,
  • Ying Yang,
  • Junru Wang,
  • Kai Liu,
  • Jiahui Zhang,
  • Juan Cao,
  • Liqun Wang

摘要

Background

The accelerating global ageing phenomenon has given rise to a growing concern regarding cognitive decline in older adults. Research shows that spouse health is closely linked to individual well-being, as the physical and emotional health of one partner significantly affects the other. Although the connection between spousal health and older adults’ cognitive function has been recognized, there is still limited research on this specific impact. This study explores how spousal health is linked to cognitive function in older adults by investigating frailty as a mediator and activity engagement as a moderator.

Methods

This study utilized data from the 2017–2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), which included a sample of 4,652 Married older adults, all aged 65 and above, living with their spouses. Cognitive function was evaluated using the Mini Mental State Examination (MMSE), frailty was measured with a frailty index, and activity engagement was gauged through various activity measures. By using mediation and moderated mediation analyses via the PROCESS macro in SPSS.

Results

Among the 4,652 participants, 209 (4.49%) had cognitive impairment. Higher spouse health scores (indicating poorer spouse health) were associated with lower cognitive function and lower activity engagement (p < 0.001), and positively associated with frailty (p < 0.001). The frailty index was also negatively associated with cognitive function (p < 0.001). Mediation analysis showed that frailty significantly mediated the association between spousal health and cognitive function (β = -0.071, SE = 0.011, 95% CI: -0.094 ~ -0.050), but direct effects were not significant. In moderated mediation analysis, activity engagement moderated the association between frailty and cognitive function, with lower participation amplifying the negative impact (low: β = -0.064; high: β = -0.051; p < 0.05).

Conclusion

This study shows a significant association between spousal health and cognitive function among older adults, with frailty serving as a fully mediator in this association. Crucially, activity engagement is associated with a weaker impact of frailty on cognitive abilities, with greater involvement linked to less pronounced cognitive decline. These findings emphasize the dual protective roles of a spouse’s health and activity engagement in sustaining cognitive health.