Trajectories of social health, cognitive, and daily functioning in community-dwelling older adults

Cognitive and functional impairments can both influence and result from deteriorating social health (SH), yet their interplay during aging remains poorly understood. This study investigated the concordance and discordance of trajectories in SH, cognitive, and daily functioning.

We analyzed 15-year follow-up data (2001-2015) from 2,848 initially dementia-free older adults in the Swedish National study on Aging and Care in Kungsholmen. Cognition and daily functioning were assessed with the Mini-Mental State Examination and activities of daily living (ADLs)/instrumental ADLs. SH encompassed indices of social participation, connections, and support. Trajectories across these five dimensions were identified using latent growth curve analyses, latent class growth analyses, and growth mixture models.

Two cognitive trajectories-relatively preserved (91%) and fast decline (9%)-and two daily functioning trajectories-stable (95%) and declining (5%)-were identified. SH trajectories included stable groups, gradually declining social participation (70%), and low initial social connections (29%). Social support showed stable (95%), declining (2%), and increasing (3%) trajectories. Women were more likely to belong to the initially low-stable social connections group, whereas higher education was linked to favorable trajectories across most dimensions but not social support. Concordance was observed among those with the lowest cognitive, daily functioning, and SH profiles. Notably, increasing social support was linked to low cognition but high daily functioning (odds ratios [OR] = 4.2, 95% CI: 2.3, 7.6).

Findings underscore the central role of SH in aging, particularly how dynamic changes in social participation, connections, and support relate to cognitive and functional outcomes.