Social contact, social support, and cognitive health in a population-based study of middle-aged and older men and women in rural South Africa.

Guy Harling,Ryan G Wagner,Stephen Tollman,Lindsay C Kobayashi,Meagan T Farrell,Lisa Berkman

doi:10.1016/j.socscimed.2020.113167

Abstract

BackgroundSeveral theories seek to explain how social connections and cognitive function are interconnected in older age. These include that social interaction protects against cognitive decline, that cognitive decline leads to shedding of social connections and that cognitive decline leads to increased instrumental support. We investigated how patterns of social contact, social support and cognitive health in rural South Africa fit with these three theories.MethodWe used data from the baseline of “Health and Aging in Africa: a Longitudinal Study of an INDEPTH community in South Africa” (HAALSI), a population-based study of 5059 individuals aged ≥ 40 years. We evaluated how a range of egocentric social connectedness measures varied by respondents' cognitive function.ResultsWe found that respondents with lower cognitive function had smaller, denser social networks that were more local and more kin-based than their peers. Lower cognitive function was associated with receipt of less social support generally, but this difference was stronger for emotional and informational support than for financial and physical support. Impairment was associated with greater differences among those aged 40–59 and those with any (versus no) educational attainment.ConclusionsThe patterns we found suggest that cognitively impaired older adults in this setting rely on their core social networks for support, and that theories relating to social connectedness and cognitive function developed in higher-income and higher-education settings may also apply in lower-resource settings elsewhere.

Highlights

Cognitive impairment is an increasing cause of morbidity in lowand-middle income countries (LMICs) and prevalence at any age is higher than that seen in higher-income settings
In this study we aimed to evaluate how interpersonal interaction, social contact and social support, is associated with cognitive function in a cohort of older rural South African adults who had limited educational opportunities
Age was inversely associated with latent cognitive Z-score, and positively associated with the likelihood of cognitive impairment; women had worse cognitive function than men, especially after age 70 (Fig. 1)

Summary

Introduction

Cognitive impairment is an increasing cause of morbidity in lowand-middle income countries (LMICs) and prevalence at any age is higher than that seen in higher-income settings This ubiquity has substantial economic and social implications (Skirbekk et al, 2012), the social drivers of cognitive health in older LMIC populations are not well understood (Lekoubou et al, 2014; Olayinka and Mbuyi, 2014). In this study we aimed to evaluate how interpersonal interaction, social contact and social support, is associated with cognitive function in a cohort of older rural South African adults who had limited educational opportunities. Conclusions: The patterns we found suggest that cognitively impaired older adults in this setting rely on their core social networks for support, and that theories relating to social connectedness and cognitive function developed in higher-income and higher-education settings may apply in lower-resource settings elsewhere

Objectives

Methods

Results

Discussion

Conclusion