The Influence of Cognitive Impairment on Health Behaviors Among Older Adults

Background/Purpose: Dementia incidence increases exponentially with age and is a significant public health problem. Evidence suggests that health behaviors, including regular physical activity, non-smoking, and moderate alcohol consumption, contribute to healthy cognitive function. Health behaviors are important for cognitively impaired older adults who are particularly susceptible to a variety of potentially preventable physical health conditions and long-term disabilities. However, previous research has predominately studied cognitive impairment as an outcome. A question seldom addressed is the extent to which cognitive impairment in older adults influences their engagement in health behaviors by impacting abilities to perceive and recognize the potential benefits of health behaviors and regulate behaviors accordingly. The purpose of this study is to examine the influence of cognitive impairment on health behaviors in older adults.

Methods: This study analyzes data from 1995 through 2012 of the Health and Retirement Study (HRS), a nationally representative longitudinal survey of noninstitutionalized individuals over 50 years of age. The respondents, who are aged ≥ 51 years at the baseline, is included in the study and the total sample size is 19,556 participants. The HRS cognitive function is measured using the Telephone Interview for Cognitive Status (TICS). A composite score of cognitive function, ranging from 0 to 27, is created by summing up scores from immediate and delayed word recall, a serial 7’s, and backwards counting. An overall score of 11 or below was defined as a cognitive impairment and a score of 6 or below was defined as dementia. Health behaviors include physical activity (participate in vigorous physical activity ≥ 3 times a week), smoking status (yes or no), and drinking level (moderate or heavy drinking criteria based on the 2015 Dietary Guidelines for Americans). Covariates include age, race/ethnicity, education, income, marital status, depression, health insurance, BMI, and chronic disease diagnoses including diabetes, cancer, stroke, heart disease, arthritis, and chronic lung disease. HRS sampling weights was adjusted to account for the HRS sample design. Mixed-effects logistic regression was used to analyze the longitudinal influence of cognitive impairment on health behaviors

Results: Older adults with cognitive impairment were 16% less likely to engage in regular physical activity during the sixteen years of follow-up (OR=0.84, 95% confidence interval [CI] = 0.80-0.89, p<.001) compared to those without cognitive impairment. Compared to their counterparts without cognitive impairment, older adults with dementia were 33% less likely to engage in regular physical activity (OR=0.67, 95% CI=0.59-0.75, p<.001). Contrary to expectations, there was no significant association at p<.05 between cognitive function and smoking and drinking behaviors among study sample.

Conclusions and Implications: Engagement in health behavior is important for older adults with cognitive impairment or dementia given that they are susceptible to other poor health conditions and disability. This study suggests that community-dwelling older adults with cognitive impairment or dementia are at risk for decreased regular physical activity engagement. Greater attention must be focused on health promotion for older adults who are already affected by cognitive impairment or dementia.