Is Social Connection the Key to Prevention? Educational Attainment and Incident Dementia and the Role of Later-Life Social Engagement

Abstract Background and Objectives Educational attainment and mid-to-later-life social engagement are modifiable risk factors for dementia, yet limited research examines how these factors interact to shape dementia risk. This study estimates the extent to which social engagement is a pathway through which education influences incident dementia, and which forms of social engagement may most reduce educational differences in incident dementia among older adults in the United States. Research Design and Methods We used survival and counterfactual decomposition analyses of the 2011-2018 National Health and Aging Trends Study to assess whether, and to what extent, different forms of social engagement mediate or moderate the influence of education on incident dementia. We compared total and controlled direct effects to assess how educational differences in incident dementia may shift under hypothetical scenarios of large discussion networks and prior-month engagement in social activities among older adults with higher and lower levels of education. Results Going out for enjoyment, visiting with friends/family, volunteering, and organized group activities were significant partial mediating pathways in the association between education and incident dementia. When prior-month volunteering, organized group activity attendance, and a large network size were modeled as mediators, educational differences in incident dementia were reduced and became statistically non-significant. Discussion and Implications Findings suggest increasing older adults’ participation in volunteering and group activities, as well as larger discussion networks, may reduce educational disparities in dementia risk. Future research should investigate the mechanisms driving these results and whether they extend to other social activities not examined in this study.