Trajectories of Social Activity Engagement and Physical and Cognitive Function During the Last Years of Life

Remaining socially active may be especially critical for quality of life as death approaches, as it affords access to necessary support, health advice, a sense of autonomy, and personal resources (e.g., coping, resilience) that shape end-of-life experiences. We aimed to examine (a) how older adults' engagement in social activities changes during the years before death, and (b) whether trajectories of engagement in these activities differ depending on physical and cognitive function.

We analyzed 22,993 annual observations from 4667 participants in the National Health and Aging Trends Study (NHATS), a U.S. nationally-representative, longitudinal study of Medicare recipients aged 65 and older who died between 2012 and 2024.

We used logistic growth curve models to test how participation in each of 5 activities-visiting with family or friends, religious service attendance, organized group activities, going out for enjoyment, and volunteering-changed over the 13 years prior to death. Key predictors included physical and cognitive function.

Findings indicated that older adults' participation in all 5 social activities declined during this final period of the life course, with considerable variation across activities. There was strong evidence that physical and cognitive function affected initial levels of participation, but minimal evidence that physical or cognitive function affected trajectories of decline.

Community-based interventions to improve physical accessibility and dementia awareness may be important avenues for supporting social activity engagement among people in the last stage of life, particularly among older adults living independently in their communities.