Department of Behavioural Science and Health, University College London Research Department of Epidemiology and Public Health, London, UK
Department of Behavioural Science and Health, University College London Research Department of Epidemiology and Public Health, London, UK.
J Epidemiol Community Health. 2020 Jan;74(1):71-77. doi: 10.1136/jech-2019-213029. Epub 2019 Oct 29.
There is increasing interest in the potential health benefits of referring older adults to engage in community leisure activities ('social prescribing') to help promote healthy cognitive ageing. However, it remains unclear whether beneficial effects of community engagement are independent of the well-known protective effects of broader structural, functional and subjective social factors.
We analysed data from 9550 adults aged 50+ from the English Longitudinal Study of Ageing, with baseline from 2004 to 2005. We assessed associations between different types of community engagement and dementia incidence over a 12-year period. Specifically, we used Cox proportional hazards models, competing risk regressions models, and modified Fine and Gray subdistribution hazards models while controlling for all identified demographic, health-related, and social covariates.
Community cultural engagement (eg, visiting museums, galleries, the theatre) was associated with a lower hazard of developing dementia in older age independent of demographic, health-related and a broad range of social factors, using all three statistical approaches (fully adjusted Cox models: HR 0.58, 95% CI 0.41 to 0.80). Community group engagement (eg, attending clubs or societies) was only associated with dementia prior to adjustment for social factors. Results were robust to sensitivity analyses considering reverse causality, over-adjustment and baseline cognitive function.
It is not just social factors that are associated with reduced risk of dementia onset, but community engagement may also be protective, particularly when relating to cultural activities. These findings are of relevance when considering the current interest in social prescribing to support healthy ageing.
越来越多的人对让老年人参与社区休闲活动（“社会处方”）以促进健康认知衰老的潜在健康益处感兴趣。然而，社区参与的有益效果是否独立于广泛的结构、功能和主观社会因素的已知保护作用，仍不清楚。
我们分析了来自英国老龄化纵向研究的 9550 名 50 岁以上成年人的数据，基线为 2004 年至 2005 年。我们评估了在 12 年期间不同类型的社区参与与痴呆症发病之间的关联。具体来说，我们使用 Cox 比例风险模型、竞争风险回归模型和修改后的 Fine 和 Gray 亚分布风险模型，同时控制所有确定的人口统计学、健康相关和社会协变量。
社区文化参与（例如，参观博物馆、画廊、剧院）与晚年痴呆症的发病风险降低相关，这与人口统计学、健康相关和广泛的社会因素无关，使用所有三种统计方法（完全调整的 Cox 模型：HR 0.58，95%CI 0.41 至 0.80）。社区团体参与（例如，参加俱乐部或社团）仅在调整社会因素之前与痴呆症相关。考虑到反向因果关系、过度调整和基线认知功能的敏感性分析，结果是稳健的。
与痴呆症发病风险降低相关的不仅仅是社会因素，而是社区参与也可能具有保护作用，尤其是与文化活动相关时。当考虑当前对社会处方的兴趣以支持健康衰老时，这些发现具有相关性。
