A Proactive Health Behavior Framework for Cognitive Impairment in Chinese Older Adults: Based on a Four-Factor and...

Objective: In the context of an aging population, the prevention and control of cognitive impairment is a key public health priority. This study aims to investigate the association between proactive health behaviors and the risk of AD8 screening positivity in older adults in China, providing an empirical basis for developing targeted intervention strategies. Methods: Based on health behavior data from 1110 older adults in China, the chi-square test was used to analyze the differences in proactive health behaviors (such as limiting salt and alcohol intake, smoking cessation, and vaccination) between the low-risk and high-risk groups for AD8 screening. Factor analysis was used to extract the main factors of proactive health behaviors. Firth penalized logistic regression models were used to analyze the impact of the main factors and sociodemographic factors on the risk of cognitive impairment. Results: The chi-square test showed that there were significant differences between the two groups in salt restriction behavior (χ² = 18.063, p < 0.01) and vaccination (χ² = 29.674, p < 0.01), with a higher proportion of salt restriction (34.7%) and vaccination rates (80.4%) in the low-risk group. Factor analysis extracted four main factors (psychological-social support, information-behavior execution, technology-environment promotion, and addictive behavior control), with a cumulative variance contribution rate of 58.45%. Among them, psychological-social support (31.42% explained variance) and information-behavior execution (28.04%) had the strongest explanatory power. Firth penalized logistic regression showed that psychological-social support (Firth-corrected OR = 0.072, 95% CI: 0.035-0.148, p < 0.01) and information-behavior execution (Firth-corrected OR = 0.008, 95% CI: 0.003-0.021, p < 0.01) had significant protective effects on AD8 screening positivity (standardized OR values indicated that each one-standard-deviation increase in these two factors reduced screening-positive risk by 39% and 53%, respectively), and the risk increased by 21.7% for every 5-year increase in age (OR = 1.217, p = 0.001). Technology-environment promotion (OR = 0.417, 95% CI: 0.250-0.691, p = 0.001) and addictive behavior control (OR = 0.709, 95% CI: 0.490-1.026, p = 0.068) showed no significant protective effects. Sensitivity analysis confirmed the robustness of the four-factor structure and core conclusions. Conclusions: Among proactive health behaviors, psychological-social support and information-behavior execution are key protective factors in reducing the risk of AD8 screening positivity in older adults, and age is an important influencing factor. Strengthening psychological support and optimizing access to health information and behavior execution can serve as core strategies for cognitive impairment prevention and control, providing empirical support for the formulation of health policies for older adults.