Subsidized senior housing and cognitive function: a moderated mediation model of social engagement and neighborhood...

Subsidized senior housing (SSH) is widely valued for its affordability and housing stability, yet its potential social benefits, particularly for cognitive health, remain underexplored. Although congregate or shared housing environments are often theorized or presumed to foster social engagement and well-being, empirical evidence remains limited, especially from longitudinal, quasi-experimental studies in the context of subsidized senior housing. This study examines whether social engagement mediates the association between SSH residency and cognitive function, and whether this indirect pathway varies by neighborhood cohesion.

We analyzed five Waves (2015-2019) of the National Health and Aging Trends Study (NHATS) using a quasi-experimental design with propensity score weighting to compare low-income older adults residing in SSH with demographically comparable peers in traditional unsubsidized housing. Weighted random-effects panel regression models with wave fixed effects and individual-clustered standard errors were used to estimate a moderated mediation model.

Older adults residing in SSH reported higher levels of social engagement than matched controls. Higher engagement was positively associated with cognitive function. The indirect association between SSH residency and cognitive function via social engagement was observed in high-cohesion neighborhoods but not in low-cohesion contexts. No direct association between SSH residency and cognitive function was found.

These findings provide a rigorous longitudinal test of a commonly assumed but rarely examined pathway linking subsidized senior housing to cognitive outcomes. Results suggest that SSH may function as a socially embedded residential context associated with cognitive health through engagement, particularly where neighborhood cohesion is strong.