The Reciprocal Causal Relationship between Social Activities and Health with Reference to the Cognitive Function Level among Community-dwelling Older Adults: A Cross-Lagged Panel Analysis

Da Eun Kim; Ju Young Yoon

doi:10.12799/jkachn.2017.28.1.13

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Kim and Yoon: The Reciprocal Causal Relationship between Social Activities and Health with Reference to the Cognitive Function Level among Community-dwelling Older Adults: A Cross-Lagged Panel Analysis

Original Article

J Korean Acad Community Health Nurs 2017;28(1):13-22.

Published online: 12 March 2017

DOI: https://doi.org/10.12799/jkachn.2017.28.1.13

The Reciprocal Causal Relationship between Social Activities and Health with Reference to the Cognitive Function Level among Community-dwelling Older Adults: A Cross-Lagged Panel Analysis

Da Eun Kim¹, Ju Young Yoon²

¹College of Nursing, Seoul National University, Seoul, Korea

²College of Nursing · Research Institute of Nursing Science, Seoul National University, Seoul, Korea

Corresponding author: Yoon, Ju Young College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-740-8817, Fax: +82-2-766-1852, E-mail: yoon26@snu.ac.kr

Received 20 December 2016 Revised 22 February 2017 Accepted 22 February 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aim of this study is to examine the reciprocal causal relationship between social activities and health with reference to the cognitive function level among community-dwelling older adults.

Methods

We conducted a longitudinal data analysis using the 4^th (Time 1) and 5^th (Time 2) waves from the Korean Longitudinal Study of Ageing adopting cross-lagged panel analysis (CLPA).

Results

A total of 3,473 community-dwelling older adults were included in the analysis: 2,053 in the normal cognitive function group, 912 in the mild cognitive impairment group, and 508 in the moderate to severe cognitive impairment group. The CLPA revealed that higher levels of social activities at Time 1 significantly influenced better subjective health perception at Time 2 in all three groups. In addition, better subjective health perception at Time 1 significantly influenced higher levels of social activities at time 2 only in the normal cognitive function group.

Conclusion

This study demonstrates that participating in social activities has positive effects on health regardless of the cognitive function level in community-dwelling older adults. This finding suggests that there is a need to develop strategies that can be used to encourage older adults with cognitive decline to maintain participation in social activities.

Keywords: Social participation, Health, Cognition, Aged, Longitudinal studies

References

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Figure 1.

Research framework of this study.

Figure 2.

Cross-lagged panel analysis results.

Table 1.

General Characteristics of the Participants at Each Time Point

Variables	Time	Total (N=3,473)	Groups			x² or F	Post-hoc	p
		Total (N=3,473)	Normal^a (n=2,053)	MCI^b (n=912)	M-S CI^c (n=508)
		n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD
Female^†	2012	2,016 (58.0)	995 (48.5)	614 (67.3)	407 (80.1)	211.24		＜.001
Age (year)	2012	73.85±6.26	72.13±5.41	75.01±6.04	78.72±6.81	288.28	c>b>a	＜.001
Income (10,000 won)	2012 2014	152.97±158.10 148.89±162.63	165.94±149.82 161.65±164.54	136.49±184.01 129.05±155.93	130.18±133.40 132.94±161.98	17.30 15.68	a>b, c a>b, c	＜.001 ＜.001
Number of chronic diseases	2012	1.63±1.29	1.46±1.21	1.80±1.31	2.04±1.42	54.07	c>b>a	＜.001
Number of chronic diseases	2014	1.85±1.35	1.68±1.28	2.00±1.38	2.28±1.44	50.43	c>b>a	＜.001
Physical function^‡	2012	10.87±2.95	10.26±1.18	10.73±2.35	13.61±5.92	309.87	c>b>a	＜.001
Physical function^‡	2014	11.32±3.83	10.57±2.27	11.41±3.73	14.23±6.62	209.68	c>b>a	＜.001
Depressive symptoms^§	2012	18.13±5.63	16.57±4.72	19.31±5.41	22.32±6.67	278.06	c>b>a	＜.001
Depressive symptoms^§	2014	17.75±5.20	16.70±4.53	18.57±5.30	20.52±6.20	134.98	c>b>a	＜.001

^† Female; reference group=male;

^‡ Instrumental Activities of Daily Living (10~30), lower scores indicate better physical function;

^§ 10-Item Center for Epidemiological Studies-Depression (CESD-10; 10~40), higher scores indicate higher levels of depressed symptoms; Normal=normal cognitive function group (K-MMSE≥24); MCI=mild cognitive impairment group (K-MMSE: 18~23); M-S CI=moderate to severe cognitive impairment group (K-MMSE≤17).

Table 2.

Descriptive Results of Health and Social Activities

Variables (Min~Max)	Time	Total (N=3,473)	Groups			F	Post-hoc	p
		Total (N=3,473)	Normal^a (n=2,053)	MCI^b (n=912)	M-S CI^c (n=508)
		n(%) or M±SD(median)	n(%) or M±SD(median)	n(%) or M±SD(median)	n(%) or M±SD(median)
Perceived subjective health (1~5)	2012	2.72±0.85 (3)	2.93±0.78 (3)	2.54±0.82 (3)	2.20±0.86 (2)	200.81	a>b>c	＜.001
Perceived subjective health (1~5)	2014	2.64±0.86 (3)	2.82±0.80 (3)	2.48±0.84 (2)	2.19±0.90 (2)	143.16	a>b>c	＜.001
Number of social activities (0~7)	2012	0.87±0.74 (1)	1.03±0.74 (1)	0.75±0.70 (1)	0.46±0.57 (0)	158.91	a>b>c	＜.001
Number of social activities (0~7)	2014	0.85±0.73 (1)	1.00±0.74 (1)	0.73±0.66 (1)	0.45±0.60 (0)	141.60	a>b>c	＜.001
Religious activities	2012	754 (21.7)	486 (23.7)	197 (21.6)	71 (14.0)
Religious activities	2014	588 (16.9)	380 (18.5)	159 (17.4)	49 (9.6)
Friendship gatherings	2012	1,780 (51.3)	1,219 (59.4)	413 (45.3)	148 (29.1)
Friendship gatherings	2014	1,848 (53.2)	1,267 (61.7)	422 (46.3)	159 (31.3)
Leisure activities	2012	120 (3.5)	88 (4.3)	27 (3.0)	5 (1.0)
Leisure activities	2014	158 (4.5)	120 (5.8)	30 (3.3)	8 (1.6)
Alumni activities	2012	353 (10.2)	306 (14.9)	43 (4.7)	4 (0.8)
Alumni activities	2014	299 (8.6)	245 (11.9)	44 (4.8)	10 (2.0)
Volunteer activities	2012	19 (0.5)	16 (0.8)	3 (0.3)	0 (0.0)
Volunteer activities	2014	15 (0.4)	14 (0.7)	1 (0.1)	0 (0.0)
Public activities	2012	4 (0.1)	4 (0.2)	0 (0.0)	0 (0.0)
Public activities	2014	5 (0.1)	4 (0.2)	1 (0.1)	0 (0.0)
Other activities	2012	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
Other activities	2014	40 (1.2)	27 (1.3)	6 (0.7)	7 (1.4)

Normal=normal cognitive function group (K-MMSE≥24); MCI=mild cognitive impairment group (K-MMSE: 18~23); M-S CI=moderate to severe cognitive impairment group (K-MMSE≤17).

Table 3.

Results of the Cross-lagged Panel Analysis

Variables	Groups
	Normal				MCI				M-S CI
	SA	Health	SA	Health	SA	Health	SA	Health	SA	Health	SA	Health
	(T1)	(T1)	(T2)	(T2)	(T1)	(T1)	(T2)	(T2)	(T1)	(T1)	(T2)	(T2)
	β (SE)	β (SE)	β (SE)	β (SE)	β (SE)	β (SE)	β (SE)	β (SE)	β (SE)	β (SE)	β (SE)	β (SE)
Health (T1)			0.10^**	0.33^**			0.02	0.28^**			0.08	0.25^**
Health (T1)			(0.02)	(0.02)			(0.03)	(0.03)			(0.04)	(0.04)
SA (T1)			0.40^**	0.05^*			0.42^**	0.06^*			0.40^**	0.12^**
SA (T1)			(0.02)	(0.02)			(0.03)	(0.03)			(0.04)	(0.03)
Female	-0.09^**	-0.10^**	-0.02	-0.01	-0.03	-0.12^**	0.01	-0.03	0.01	0.01	-0.03	0.01
Female	(0.02)	(0.02)	(0.02)	(0.02)	(0.03)	(0.03)	(0.03)	(0.03)	(0.04)	(0.04)	(0.04)	(0.04)
Age (year)	-0.09^**	-0.10^**	-0.10^**	-0.08^**	-0.09^**	-0.05	-0.02	-0.02	-0.03	0.06	0.03	0.05
Age (year)	(0.02)	(0.02)	(0.02)	(0.02)	(0.03)	(0.03)	(0.03)	(0.03)	(0.05)	(0.04)	(0.04)	(0.04)
Income (10,000 won)	0.17^**	0.13^**	0.05^*	0.04^*	0.12^**	0.08	0.06	0.05	0.07	0.13^**	-0.01	0.13^**
Income (10,000 won)	(0.04)	(0.02)	(0.02)	(0.02)	(0.04)	(0.04)	(0.03)	(0.03)	(0.04)	(0.04)	(0.04)	(0.04)
Number of chronic diseases	0.00	-0.28^**	-0.01	-0.15^**	0.03	-0.28^**	-0.09^**	-0.17^**	-0.03	-0.22^**	0.05	-0.12^**
Number of chronic diseases	(0.02)	(0.02)	(0.02)	(0.02)	(0.04)	(0.03)	(0.03)	(0.03)	(0.05)	(0.04)	(0.05)	(0.03)
Physical function	-0.02	-0.11^**	-0.08^**	-0.17^**	-0.08^**	-0.15^**	-0.10^**	-0.26^**	-0.16^**	-0.33^**	-0.11^**	-0.33^**
Physical function	(0.02)	(0.02)	(0.02)	(0.03)	(0.03)	(0.03)	(0.02)	(0.03)	(0.05)	(0.04)	(0.04)	(0.04)
Depressive symptoms	-0.07^**	-0.13^**	0.00	-0.16^**	-0.11^**	-0.22^**	-0.11^**	-0.15^**	-0.10^*	-0.25^**	-0.15^**	-0.17^**
Depressive symptoms	(0.02)	(0.02)	(0.02)	(0.03)	(0.03)	(0.03)	(0.03)	(0.04)	(0.05)	(0.03)	(0.04)	(0.04)

^* p＜.05,

^** p＜.01; Normal=normal cognitive function group (K-MMSE≥24); MCI=mild cognitive impairment group (K-MMSE: 18~23); M-S CI=moderate to severe cognitive impairment group (K-MMSE≤17); SA=social activity; ß=standardized coefficient; SE=standard error.

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