Mild cognitive impairment, Spirituality, and All-cause Mortality Among Older Adults in Mainland China: A Prospective Cohort Study

Abstract

Abstract Background: The association between spirituality, cognitive function, and risk of mortality is still unknown among older adults in mainland China. Methods: Data from a prospective cohort study of 4,705 community-dwelling older adults, including 915 with MCI, were analyzed. Measures included the Duke University Religion Index (DUREL), which assessed the spirituality of the participants from years 2012 to 2016 (baseline). All-cause mortality records were linked with the National Cause of Death Surveillance System in the years 2017, 2019, and 2021. Cox proportional hazards regression modeling was used to estimate hazard ratios (HR) and 95% confidence intervals to assess the effects of MCI and spirituality on all-cause mortality. In addition, the interaction between spirituality and MCI in predicting all-cause mortality was examined using moderation modeling. Results: A total of 387 deaths were identified during an average follow-up time of 87.3 months (SD=20.8). MCI was associated with an increased risk of all-cause mortality (HR=2.07, 95%CI: 1.58-2.72), while high spirituality was associated with decreased risk of all-cause mortality (HR=0.65, 95%CI: 0.49-0.86). Interaction effect of MCI and spirituality on all-cause mortality after adjusting for covariates (Relative Excess Risk of Interaction=0.82; Attributable Proportion =0.27; Synergy Index=1.67) was found, participants with low spirituality and MCI had the highest risk of mortality (HR=3.30, 95%CI: 2.40~4.52). Conclusions: MCI predicted an increased risk of all-cause mortality among Chinese older adults, and spirituality predicted a reduced risk. The findings suggest that a spiritually-integrated community intervention program may reduce the risk of mortality in older adults with cognitive impairment.