Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Bauer, Greta R.

Abstract

Normative cognitive decline is an emerging public health issue for older adult populations. It is necessary that we take an intersectional approach to examining heterogeneity in cognitive health outcomes. Using complex longitudinal survey data from the English Longitudinal Study of Ageing (ELSA), multiple linear regression models were used to examine the relationship between intersectional group membership based on age, education, and sex, and change in cognitive functioning domains (memory function, and executive function) over an 8-year period. Three-way decomposition analysis was also used to examine the mediating effect of loneliness on the association between intersectional group membership and the change in cognition domains. Intersectional group membership was found to be significantly associated with changes in memory function and executive function over time. However, loneliness was not observed to have a significant mediating effect on the relationship between intersectional group membership and the change in cognition outcomes.

Summary for Lay Audience

Cognitive decline is an emerging public health issue for cognitive-disease free older adult populations. Memory function and executive function are two key areas of cognitive health in old age. Declines in memory and executive function weaken an individual’s ability to function independently in day-to-day life in activities such as taking daily medications or being able to perform self-care practices. Loneliness refers to poor feelings caused by differences in the expected quality and the received quality of an individual’s social relationships. Frequent feelings of loneliness are also a key public health concern in aging populations they have been linked to negative physical and emotional health outcomes.

Intersectionality is a framework that refers to the interlocking relationship between an individual’s multiple social identities. Intersectionality is commonly used to examine disparities in health in the population. To better understand cognitive health, we must examine how people with different interlocking social identities, commonly referred to as belonging to an intersectional group, experience changes in cognitive health over time. As well, it is important to examine how modifiable factors like loneliness potentially influence the disparities we observe amongst different intersectional groups.

This thesis used data from Wave 4 (2008 to 2009) and Wave 8 (2016 to 2017) of the English Longitudinal Study of Ageing (ELSA), a sample of older adults age 50 years and over living in England. In this study, we found that intersectional groups based on age group, biological sex, and education level, experienced differences in the decline in memory function and executive function over an 8-year time-period. Specifically, individuals who belonged to the group Females age 65 years and older with high levels of education attainment declined at a quicker pace when compared to those who were Male 50 to 64 years old with low educational attainment. Additionally, while these groups experienced disparities in memory functioning and executive functioning over time, differences in their levels of loneliness did not play a large role in the disparities that we observed. Disparities in cognitive decline would persist even if each intersectional group experienced loneliness at the same level. Intersectionality is a framework that refers to the interlocking relationship between an individual’s multiple social identities. Intersectionality is commonly used to examine disparities in health in the population. To better understand cognitive health, we must examine how people with different interlocking social identities, commonly referred to as belonging to an intersectional group, experience changes in cognitive health over time. As well, it is important to examine how modifiable factors like loneliness potentially influence the disparities we observe amongst different intersectional groups.

This thesis used data from Wave 4 (2008 to 2009) and Wave 8 (2016 to 2017) of the English Longitudinal Study of Ageing (ELSA), a sample of older adults age 50 years and over living in England. In this study, we found that intersectional groups based on age group, biological sex, and education level, experienced differences in the decline in memory function and executive function over an 8-year time-period. Specifically, individuals who belonged to the group Females age 65 years and older with high levels of education declined at a quicker pace when compared to those who were Male 50 to 64 years old with low educational attainment. Additionally, while these groups experienced disparities in memory functioning and executive functioning over time, differences in their levels of loneliness did not play a large role in the differences that we observed. Disparities in cognitive decline would persist even if each intersectional group experienced loneliness at the same level.

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