Associations Between Social Isolation, Education, and Rurality and Cognitive Health in the LASI Study

TL;DR

This study finds that social isolation is linked to worse cognitive health in older adults in India, with education playing a moderating role, especially in urban areas.

Contribution

The study introduces a multidimensional Social Isolation Index and identifies how education modifies its cognitive effects in urban settings.

Findings

Higher social isolation scores correlate with lower cognitive function scores in older adults.

Education moderates the negative impact of social isolation on cognition, particularly in urban areas.

The association between social isolation and cognition remains significant even after adjusting for multiple factors.

Abstract

Social isolation is increasingly recognized as a risk factor for cognitive decline, yet its measurement and implications remain underexamined in low- and middle-income countries. This study examines various indicators of the multidimensional Social Isolation Index (SII) and its association with cognitive functioning among older adults in India. We used nationally representative data from the Longitudinal Aging Study in India (LASI) Wave 1 (2017–2019), focusing on individuals aged ≥60 years (N = 31,300) across 34 states and union territories. The SII combined six indicators (marital status, household structure, child contact, social and religious participation, and loneliness) into a weighted index (0-1). Cognitive function was measured using the composite cognitive index score (0-43). Linear regression models were used to assess the association between SII and cognition after sequential adjustment for socio-demographic, health, and behavioral covariates. Moderation was tested through interaction terms with rurality and education. A higher SII score was associated with lower cognitive functioning, with a 1.04-point difference between the most and least isolated individuals (95% CI: −1.13, −0.96). This association remained robust after full adjustment (−0.67, 95% CI: −0.74, −0.59). No rural-urban differences were observed. Educational attainment moderated the association, particularly in urban settings, where the association was weaker among those with higher education. SSI is consistently associated with lower cognitive functioning in later life, with education appearing to modify this association, particularly in urban settings. Understanding the effects of both objective and subjective dimensions of isolation is crucial for developing strategies to support healthier aging and improve cognitive health.