Korean J Health Promot.  2023 Sep;23(3):105-116. 10.15384/kjhp.2023.23.3.105.

Trajectories of Cognitive Function and Their Associated Factors in Community-Dwelling Older Adults by Living Arrangement Using the Korean Longitudinal Study of Aging

• Son YJ
• Kim SH

• KMID: 2546773
• DOI: http://doi.org/10.15384/kjhp.2023.23.3.105

Abstract

Background
The purpose of this study was to describe the distinct cognitive trajectories for 8 years according to living arrangement among community-dwelling older adults using the Korean longitudinal study of ageing.
Methods
We analyzed data from a final sample of 3,049 community-dwelling older adults aged 65 years or older who participated in at least three cognitive function measures in an 8-year period (2012-2020). Cognitive function was assessed by Korean mini mental state examination. Latent class growth model analysis was applied to determine the number and shape of trajectories of older adults according to living arrangement. Multinomial logistic regression analysis was used to determine risk factors for cognitive function trajectories.
Results
We identified five trajectory patterns in cognitive function among older adults living alone; ‘high-stable (35.6%)’, ‘high-declining (32.5%)’, ‘moderate-steep declining (6.2%)’, ‘low-stable (18.9%)’, and ‘low declining (6.8%)’. In older adults living with family, there were four trajectory patterns; ‘high-stable (46.4%)’, ‘high-declining (32.0%)’, ‘low-stable (15.9%)’, and ‘low-declining (5.7%)’. Age, instrumental activities of daily living, and depression were common factors of cognitive changes in both older adults living alone and those living with family members. However, monthly incomes was only associated with the risk of cognitive function in older adults living alone.
Conclusions
We found that cognitive function trajectories among older adults may differ depending on the type of living arrangement. Therefore, further studies and health policies are required for avoiding cognitive impairment by living arrangement among older adults based on the results of this study.

Keyword

Aged; Cognitive dysfunction; Longitudinal studies; Residence characteristics

Figure

• 

  Fig. 1. Flowchart of subjects included in the study. K-MMSE, Korean mini mental state examination; CES-D10, center for epidemiological studies-depression scale-10.

• 

  Fig. 2. Latent classes of cognitive function trajectories by living arrangement. K-MMSE, Korean mini mental state examination; KLoSA, Korean Longitudinal Study of Ageing.

Reference

1. Statistics Korea. Population prospects of the world and South Korea [Internet]. Daejeon: Statistics Korea; 2022 [cited Apr 5, 2023]. Available from: https://kostat.go.kr/board.es?mid=a10301020200&bid=203&act=view&list_no=426429.

2. Urtamo A, Jyväkorpi SK, Strandberg TE. Definitions of successful ageing: a brief review of a multidimensional concept. Acta Biomed. 2019; 90(2):359–63.

3. Aspell N, O'Sullivan M, O'Shea E, Irving K, Duffy C, Gorman R, et al. Predicting admission to long-term care and mortality among community-based, dependent older people in Ireland. Int J Geriatr Psychiatry. 2019; 34(7):999–1007.

4. Wu Z, Woods RL, Wolfe R, Storey E, Chong TTJ, Shah RC, et al. Trajectories of cognitive function in community-dwelling older adults: a longitudinal study of population heterogeneity. Alzheimers Dement (Amst). 2021; 13(1):e12180.

5. National Institute of Dementia. Nationwide survey on the dementia epidemiology of Korea [Internet]. Seoul: National Institute of Dementia; 2022 [cited Apr 18, 2023]. Available from: https://www.nid.or.kr/main/main.aspx.

6. Zhang Q, Wu Y, Han T, Liu E. Changes in cognitive function and risk factors for cognitive impairment of the elderly in China: 2005-2014. Int J Environ Res Public Health. 2019; 16(16):2847.

7. Yaffe K, Vittinghoff E, Hoang T, Matthews K, Golden SH, Zeki Al Hazzouri A. Cardiovascular risk factors across the life course and cognitive decline: a pooled cohort study. Neurology. 2021; 96(17):e2212–9.

8. Shin J, Cho E. Patterns and risk factors of cognitive decline among community-dwelling older adults in South Korea. Arch Gerontol Geriatr. 2023; 104:104809.

9. Hu X, Gu S, Sun X, Gu Y, Zhen X, Li Y, et al. Cognitive ageing trajectories and mortality of Chinese oldest-old. Arch Gerontol Geriatr. 2019; 82:81–7.

10. Chen TY, Chang HY. Developmental patterns of cognitive function and associated factors among the elderly in Taiwan. Sci Rep. 2016; 6:33486.

11. Wu Z, Woods RL, Chong TT, Orchard SG, McNeil JJ, Shah RC, et al. Potential modifiable factors associated with late-life cognitive trajectories. Front Neurol. 2022; 13:950644.

12. Srivastava S, Shaw S, Chaurasia H, Purkayastha N, Muhammad T. Feeling about living arrangements and associated health outcomes among older adults in India: a cross-sectional study. BMC Public Health. 2021; 21(1):1322.

13. Lee YH, Lin CH, Chang JR, Liu CT, Shelley M, Chang YC. Transition of living arrangement and cognitive impairment status among Chinese older adults: are they associated? Medicina (Kaunas). 2021; 57(9):961.

14. Roystonn K, Abdin E, Shahwan S, Zhang Y, Sambasivam R, Vaingankar JA, et al. Living arrangements and cognitive abilities of community-dwelling older adults in Singapore. Psychogeriatrics. 2020; 20(5):625–35.

15. Yu Y, Lv J, Liu J, Chen Y, Chen K, Yang Y. Association between living arrangements and cognitive decline in older adults: a nationally representative longitudinal study in China. BMC Geriatr. 2022; 22(1):843.

16. Yoon D, Jun HJ, Lee SA. Patterns of cognitive function trajectory and their associated factors in Korean older women in single households. Innov Aging. 2020; 4(Suppl 1):294.

17. Desai R, John A, Stott J, Charlesworth G. Living alone and risk of dementia: a systematic review and meta-analysis. Ageing Res Rev. 2020; 62:101122.

18. Vetrano DL, Rizzuto D, Calderón-Larrañaga A, Onder G, Welmer AK, Bernabei R, et al. Trajectories of functional decline in older adults with neuropsychiatric and cardiovascular multimorbidity: a Swedish cohort study. PLoS Med. 2018; 15(3):e1002503.

19. Zhang B, Jiang S. Heterogeneity in longitudinal trajectories of cognitive performance among middle-aged and older individuals with hypertension: growth mixture modeling across an 8-year cohort study. Hypertens Res. 2022; 45(6):1037–46.

20. Korea Employment Information Service. 2020 Korean longitudinal study of ageing (KLoSA) basic analysis report [Internet]. Eumseong: Korea Employment Information Service; 2022 [cited Apr 20, 2023]. Available from: https://survey.keis.or.kr/klosa/klosa04.jsp.

21. Kim BY, Kang SM, Kang JH, Kang SY, Kim KK, Kim KB, et al. 2020 Korean society for the study of obesity guidelines for the management of obesity in Korea. J Obes Metab Syndr. 2021; 30(2):81–92.

22. Skou ST, Mair FS, Fortin M, Guthrie B, Nunes BP, Miranda JJ, et al. Multimorbidity. Nat Rev Dis Primers. 2022; 8(1):48.

23. Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D (center for epidemiologic studies depression scale). Am J Prev Med. 1994; 10(2):77–84.

24. Irwin M, Artin KH, Oxman MN. Screening for depression in the older adult: criterion validity of the 10-item center for epidemiological studies depression scale (CES-D). Arch Intern Med. 1999; 159(15):1701–4.

25. Kang Y, NA DL, Hahn S. A validity study on the Korean mini-mental state examination (K-MMSE) in dementia patients. J Korean Neurol Assoc. 1997; 15:300–8.

26. Jung T, Wickrama KA. An introduction to latent class growth analysis and growth mixture modeling. Soc Personal Psychol Compass. 2008; 2(1):302–17.

27. Howrey BT, Raji MA, Masel MM, Peek MK. Stability in cognitive function over 18 years: prevalence and predictors among older Mexican Americans. Curr Alzheimer Res. 2015; 12(7):614–21.

28. Tu L, Lv X, Yuan C, Zhang M, Fan Z, Xu X, et al. Trajectories of cognitive function and their determinants in older people: 12 years of follow-up in the Chinese longitudinal healthy longevity survey. Int Psychogeriatr. 2020; 32(6):765–75.

29. Zaninotto P, Batty GD, Allerhand M, Deary IJ. Cognitive function trajectories and their determinants in older people: 8 years of follow-up in the english longitudinal study of ageing. J Epidemiol Community Health. 2018; 72(8):685–94.

30. Yu M, Gu L, Jiao W, Xia H, Wang W. Predictors of self-neglect among community-dwelling older adults living alone in China. Geriatr Nurs. 2019; 40(5):457–62.