Association between community-based services, psychological resilience, and cognitive impairment among older adults in China

Abstract

Abstract Cognitive impairment (CI) has emerged as a critical global public health concern, particularly among older adults. Community-based services (CBSs) and psychological resilience (PR) are potential protective factors, yet their interrelationships remain underexplored. This study examines how CBSs influence CI among older adults and whether PR mediates this association. Based on data from 7,565 individuals aged ≥ 65 in the China Longitudinal Health Longevity Survey (CLHLS), the structural equation modeling was used to test direct and indirect pathways between CBSs, PR, and CI, adjusting for eighteen basic demographic covariates. Mediation effects were validated via the Bootstrap 2000 method. The findings highlight that CBSs are positively associated with both lower CI (β = 0.049, P < 0.001) and higher PR (β = 0.071, P < 0.001), while PR associates with CI risk positively (β = 0.260, P < 0.001). PR mediated 26.87% of the total CBSs-CI association (indirect effect = 0.018, 95%CI: 0.012–0.026). Specific CBSs, including doctors or sending medicine to home (χ 2 = 7.05, P = 0.008) and health care education (χ 2 = 7.89, P = 0.005), showed a strong protective effect against CI. These results underscore the importance of enhancing CBSs and fostering PR to mitigate CI and promote healthy aging. A collaborative effort between communities and society is essential to empower older adults, strengthen their PR and facilitate active aging.