Paid work participation and cognitive function trajectories among older adults in China: evidence from a longitudinal study

OBJECTIVES: Evidence on the association between work and cognitive ageing has been mixed, and research from China remains limited, particularly with respect to heterogeneity in cognitive function trajectories. This study examined whether paid work participation in later life is associated with distinct cognitive function trajectories among older Chinese adults. METHODS: Data were obtained from four waves (2013, 2015, 2018, and 2020) of the China Health and Retirement Longitudinal Study (CHARLS). The analytical sample comprised 3,590 adults aged 60 years or older. Group-based trajectory modeling (GBTM) was used to identify distinct trajectories of cognitive function over time. Multinomial logistic regression models were employed to examine the associations between paid work participation and trajectory membership. The Karlson-Holm-Breen (KHB) method was applied to assess the mediating role of digital access. Additional analyses further explored work type and regional heterogeneity. RESULTS: Three cognitive function trajectories were identified: a Low-level rapid decline group, a Moderate-level slow decline group, and a High-level stable group. Compared with nonparticipants, older adults engaged in paid work were more likely to belong to the Moderate-level slow decline and High-level stable groups. Mediation analyses indicated that digital access partially mediated the association with membership in the High-level stable group, whereas no clear mediation effect was observed for the Moderate-level slow decline group. Across different types of paid work, participation was consistently associated with more favorable cognitive function trajectories, with variations in effect magnitude across work types. The positive association between paid work participation and favorable cognitive function trajectories appeared stronger among older adults living in central-western regions. DISCUSSION: In this nationally representative longitudinal study, paid work participation in later life was associated with more favorable cognitive ageing trajectories among older Chinese adults. These findings underscore the importance of moving beyond a binary distinction between working and not working, and of considering work characteristics and supportive employment environments when assessing the role of paid work in promoting cognitive health in later life.