Associations Of Leisure Activity With Cognitive Impairment,Activities Of Daily Living Disability,and All-cause Mortality Among The Chinese Oldest-old Population

ObjectiveTo investigate associations of leisure activities with cognitive impairment,activities of daily living(ADL)disability and all-cause mortality among the Chinese oldest-old(80 years and older)population.MethodsThis community-based prospective cohort study included Chinese oldest-old from the Chinese Longitudinal Healthy Longevity Survey 1998-2014.At baseline,the participants were interviewed regarding their engagement in six leisure activities,including watching TV or listening to radio,reading newspapers or books,playing cards or mah-jong,gardening,keeping domestic animals or pets,and attending religious activities.The participants reported their frequency of participation as"almost every day," "sometimes," or "never" for each individual activity.Cox proportional hazards models were used to estimate associations of leisure activities with cognitive impairment,ADL disability and all-cause mortality,respectively.Results(1)Leisure activities and cognitive impairment:this study included 10,741 cognitively normal Chinese oldest-old(41,518 person-years),2,894 participants developed cognitive impairment.The incidence(per 1,000 person-years)of cognitive impairment was 69.7.Compared to those who "never“engaged in watching TV or listening to radio,reading books or newspapers,and playing cards or mah-jong,those who engaged in such activities "almost every day" and "sometimes" reduced their risk of cognitive impairment,the adjusted hazard ratios were 0.50(95%CI:0.45-0.55)for "almost every day" and 0.71(95%CI:0.64-0.77)for "sometimes" watching TV or listening to radio;0.74(95%CI:0.65-0.86)for"almost every day" and 0.62(95%CI:0.51-0.76)for "sometimes" playing cards or mah-jong;and 0.74(95%CI:0.65-0.84)for "almost every day" reading book or newspaper.The association between the risk of cognitive impairment and watching TV and listening to the radio,reading books or newspapers,and playing cards or mah-jong were stronger among those who had one or more years of education(all P-interactions<0.05).(2)Leisure activities and ADL disability:this study included 12,331 Chinese oldest-old(75,737 person-years),3,696 participants developed cognitive impairment.The incidence(per 1,000 person-years)of cognitive impairment was 48.8.Compared to the participants who "never" watched TV or listened to the radio and who "never"kept domestic animals or pets,those who engaged in these activities "almost every day" had a significantly lower ADL disability risk(adjusted hazard ratios were 0.74(95%CI:0.68-0.81)and 0.66(95%CI:0.59-0.73),respectively).(3)Leisure activities and all-cause mortality:this study included 30,070 Chinese oldest-old(108,329 person-years),23,629 participants developed death.The incidence(per 1,000 person-years)of cognitive impairment was 218.1.Compared to those who "never" engaged in watching TV or listening to the radio,playing cards or mah-jong,reading books or newspapers,gardening,keeping domestic animals or pets,or attending religious activities,those who engaged in such activities "almost every day" reduced their risk of mortality,the hazard ratios were 0.83(95%CI:0.80-0.86),0.85(95%CI:0.80-0.91),0.87(95%CI:0.82-0.93),0.89(95%CI:0.82-0.96),0.82(95%CI:0.78-0.86)and 0.85(95%CI:0.78-0.93),respectively.Conclusions(1)A greater frequency of TV watching or radio listening,playing cards or mahjong and reading books or newspapers may decrease the risk of cognitive impairment among the oldest-old;(2)A greater frequency of watching TV or listening to the radio and keeping domestic animals or pets was associated with a lower risk of ADL disability among the oldest-old Chinese population;(3)A greater frequency of participation in leisure activities might help decrease the risk of death in the Chinese oldest-old population.