Relationship between left-behind status and cognitive function in older Chinese adults: a prospective 3-year cohort study

Background Due to the inaccuracy of the traditional geographical distance-based definition of left-behind status,data on the negative effect of left-behind status on cognitive function among older adults are controversial.Aims This study examined the cross-sectional and longitudinal associations of left-behind status with cognitive function in older Chinese adults.The left-behind status definition was based on the frequency of face-to-face parent-child meetings.Methods Data from a nationally representative sample of 8682 older adults(60+years)in 2015(5658 left behind and 3024 non-left behind),of which 6933 completed the follow-up in 2018,were obtained from the China Health and Retirement Longitudinal Study.Left-behind older adults werebroadlydefined as those aged 60+years who had living adult children and saw their children less than once per month.The cognitive function was assessed with a composite cognitive test with higher total scores indicating better cognitive function.Results Left-behind older adults had significantly lower cognitive test scores than non-left-behind older adults in both 2015(11.1(6.0)vs 13.2(5.9),t=15.863,p<0.001)and 2018(10.0(6.6)vs 12.4(6.7),t=14.177,p<0.001).After adjusting for demographic factors,lifestyle factors,chronic medical conditions and the baseline cognitive test score(in the longitudinal analysis only),on average,the cognitive test score of left-behind older adults was 0.628 lower than their non-left-behind counterparts in 2015(t=5.689,p<0.001).This difference in cognitive test scores attenuated to 0.322 but remained significant in 2018(t=2.733,p=0.006).Conclusions Left-behind older Chinese adults have a higher risk of poor cognitive function and cognitive decline than their non-left-behind counterparts.Specific efforts targeting left-behind older adults,such as encouraging adult children to visit their parents more regularly,are warranted to maintain or delay the progression of cognitive decline.