Digital Engagement and Cognitive Function Among Older Adults in China: Cross-Sectional Questionnaire Study and Moderated Mediation Model Analysis.

Abstract

Given the global demographic shifts and rapid digitalization, digital engagement has emerged as a critical determinant of healthy aging. While previous research has linked digital engagement to cognitive outcomes, the underlying mechanisms remain underexplored among Chinese older adults. This study aimed to analyze the relationships between digital engagement and cognitive function among older adults in China through a moderated mediation model guided by the technological reserve hypothesis, with digital health literacy (DHL) and social support as mediators and living arrangements as a moderator. We conducted a cross-sectional questionnaire survey using stratified multistage sampling from June to November 2024, including 8123 participants aged 55 years and older. Digital engagement, defined as older adults' use of contemporary digital technologies to support routine daily activities, autonomy, independence, and social inclusion, was assessed using a multidimensional questionnaire. The Chinese eHealth Literacy Scale, the 3-item short version of the Perceived Social Support Scale, and the Mini-Cog test were used to assess DHL, social support, and cognitive function. Guided by a directed acyclic graph based on the technological reserve hypothesis, mediation and moderated mediation analyses were performed using the PROCESS macro in SPSS (IBM Corp) with 5000 bootstrap resamples. Digital engagement was positively associated with cognitive function among older adults (β=0.241, 95% CI 0.216-0.265). This association was partially mediated by DHL (β=0.059, 95% CI 0.049-0.069) and social support (β=0.012, 95% CI 0.008-0.016), with the combined indirect effects accounting for 29.5% of the total effect (β=0.071, 95% CI 0.061-0.082). Additionally, living arrangements significantly moderated the associations between digital engagement and cognitive function (β=0.109, 95% CI 0.052-0.166), digital engagement and DHL (β=0.063, 95% CI 0.014-0.112), and digital engagement and social support (β=0.151, 95% CI 0.089-0.212). These effects were stronger among older adults living alone. This study contributes to the understanding of cognitive aging in the digital environment from the perspective of the technological reserve hypothesis and digital engagement. Digital engagement influenced cognitive function via DHL and social support, and these associations of digital engagement with cognitive function, DHL, and social support were stronger among older adults living alone. Digital health interventions and public health policies should target both DHL and social support among older populations and prioritize older adults living alone.