Association between perceived value of adopting new behaviors and incident disability among Japanese community-dwelling older adults.

OBJECTIVES: This longitudinal observational cohort study aimed to clarify the relationship between perceived value (PV) to adopt new behaviors and incident disability in community-dwelling older adults. METHOD: Participants were 5073 community-dwelling older adults aged ≥65 years in Japan (Mage = 74.0 ± 5.6 years; female = 55.1%). The mean follow-up time was 34.5 months. Baseline data were collected during health checkups in a prospective cohort study. Measurements included engagement in physical activity (PA), cognitive activity (CA), and social activity (SA), PV, health and physical conditions, and demographic characteristics. PV was assessed by asking whether participants thought it was valuable to adopt new behaviors related to PA, CA, and SA. Participants were classified as having higher/lower PV, PA, CA, and SA. Cox proportional hazard models were used to analyze the association between PV and incident disability. PV was examined both as an independent variable and in combination as follows: higher PV and higher PA/CA/SA (high/high); lower PV and higher PA/CA/SA (low/high); higher PV and lower PA/CA/SA (high/low); and lower PV and lower PA/CA/SA (low/low). RESULTS: Higher PV was significantly associated with a lower hazard ratio (HR) for incident disability. The low/high, high/low, and low/low significantly increased the HR compared to high/high in the analyses of PV & PA and CA. The analysis of PV & SA showed that only low/low increased the HR compared to high/high. CONCLUSION: Having both higher PV and higher activity engagement may contribute to preventing disability development. Both support for activities and value education in older adults may be needed.

Depression, loneliness, and lower social activity as partial mediators of the association between visual impairment and cognitive decline.

OBJECTIVES: Sensory impairment is a hypothesized risk factor for cognitive decline; however, the psychosocial pathways are not well understood. We evaluated whether the association between visual impairment (VI) and cognitive decline was partially mediated via depressive symptoms, loneliness, or social activity. METHODS: We used data from 2601 older adults enrolled in the Memory and Aging Project in 1997 and the Minority Aging Research Study in 2004 with neuropsychological tests across five domains measured annually for up to 16 years. VI was assessed with the Rosenbaum Pocket Vision Screener. Depressive symptoms, loneliness, and social activity were self-reported using validated scales. We used structural equation models to estimate the associations of VI with baseline and change in cognitive function, directly and indirectly through each mediator (depressive symptoms, loneliness, and social activity). We evaluated mediation via "psychological distress" using a latent variable combining depressive symptoms and loneliness. RESULTS: The association between VI and global cognitive decline was mediated via lower social activity (indirect effect) [95% confidence interval (CI)] of linear slope: -0.025 (-0.048, -0.011), via loneliness (-0.011 [95% CI: -0.028, -0.002]), and via psychological distress (-0.017 [95% CI: -0.042, -0.003]). We did not find sufficient evidence for mediation via depressive symptoms alone. CONCLUSIONS: The harmful effect of VI on cognitive decline may be partially mediated through loneliness and lower social activity.

Factors associated with social participation among community-dwelling frail older adults in Japan: a cross-sectional study.

BACKGROUND: In recent years, it has become clear that participation in social activities by the older adult suppresses their need for long-term care. Likewise, social participation can promote long-term care prevention among frail older adults who are at a higher risk of needing long-term care. However, their social participation rate is low, and the factors causing these low rates of participation are unclear. Therefore, this study identifies the factors affecting social participation of frail older adults. METHODS: After excluding those certified as requiring long-term care, 28,636 older adults within the target region were selected to receive questionnaires. The questionnaires were distributed and collected via mail. A total of 22,048 respondents (77.0%), including 9,325 men and 10,150 women, were included; 2,655 frail older adults were identified for analysis. Questionnaire items inquired about social participation, basic attributes, need for long-term care, mobility, subjective health, direct and indirect contact with relatives living separately and direct and indirect contact with friends and neighbors. For the statistical analysis, this study employed a binomial logistic regression analysis with social participation as the objective variable. RESULTS: The rate of social participation among frail older adults was 13.7%. Items related to social participation included sex, economic status, mobility, subjective health, direct contact with friends, and indirect contact with friends. CONCLUSIONS: Interactions with friends and neighbors and physical functionality are correlated with levels of social participation among frail older adults, suggesting that social participation can be promoted by maintaining friendships, forming new ones, and maintaining and improving physical functionality.

Association of frailty with workplace social activity, physical activity, and well-being among older employees: a moderated mediation in two income-variant samples.

BACKGROUND: Research suggests that frailty is associated with lower physical activity and well-being in old age, but social activities at work may facilitate physical activity and its positive effect on well-being among older employees with frailty. This study, therefore, ascertained whether there is a moderated mediation of the association of frailty, Workplace Social Activity (WSA), and well-being by Physical Activity (PA). METHODS: The study adopted a cross-sectional design with relevant sensitivity analyses for confounding. The participants were within two Ghanaian samples with different income levels (low-income, n = 897, and higher income, n = 530). The minimum samples were calculated, and the statistical models were tested with Haye's Process Model through structural equation modelling. RESULTS: Frailty was negatively associated with PA, and this relationship was moderated by WSA in both samples. Higher frailty was directly and indirectly associated with lower well-being in the higher-income sample but only indirectly associated with lower well-being in the low-income sample. The mediation of PA in the frailty-well-being relationship is partial in the higher-income sample but complete in the low-income sample. There was evidence of moderated mediation in both samples. CONCLUSION: WSA may reduce the strength of the negative association of frailty with PA and well-being among older employees in both samples. Workplace interventions aimed at enhancing WSA may encourage PA and enhance well-being among older employees with frailty.

Exploring social activity patterns among community-dwelling older adults in South Korea: a latent class analysis.

BACKGROUND: With the trend of digitalization, social activities among the older population are becoming more diverse as they increasingly adopt technology-based alternatives. To gain a comprehensive understanding of social activities, this study aimed to identify the patterns of digital and in-person social activities among community-dwelling older adults in South Korea, examine the associated factors, and explore the difference in depressive symptoms by the identified latent social activity patterns. METHODS: Data were extracted from a nationwide survey conducted with 1,016 community-dwelling older adults (mean age 68.0 ± 6.5 years, 47.8% male). The main variables assessed were digital social activities (eight items), in-person social activities (six items), and depressive symptoms (20 items). Data were analyzed using latent class analysis, multinomial logistic regression, and multiple linear regression. RESULTS: We identified four distinct social activity patterns: "minimal in both digital and in-person" (22.0%), "moderate in both digital and in-person" (46.7%), "moderate in digital & very high in in-person" (14.5%), and "high in both digital and in-person" (16.8%). Younger age, living in multi-generational households, and higher digital literacy were associated with a higher likelihood of being in the "moderate in both digital and in-person" than the "minimal in both digital and in-person" group. Younger age, male, living in multi-generational households, residing in metropolitan areas, no dependency on IADL items, doing daily physical exercise, and higher digital literacy were associated with a higher likelihood of being in the "moderate in digital & very high in in-person" than the "minimal in both digital and in-person" group. Younger age, living in multi-generational households, no dependency on IADL items, doing daily physical exercise, and higher digital literacy were associated with a higher likelihood of being in the "high in both digital and in-person" than the "minimal in both digital and in-person" group. Depressive symptoms were significantly higher in the group with minimal engagement in both digital and in-person activities, compared to other three groups. CONCLUSIONS: This study highlights distinct patterns of social activities among Korean community-dwelling older adults. Since older adults with minimal social activity engagement can be more vulnerable to depressive symptoms, interventions that address modifiable attributes, such as supporting digital literacy and facilitating physical activity of older adults, could serve as potential strategies to enhance their social activity engagement and, consequently, their mental well-being.

Social participation classification and activities in association with health outcomes among older adults: Results from a scoping review.

AIMS: The aim of this study is to summarize the characteristics of social participation classification and examine the association between activities and health outcomes among older adults. DESIGN: Scoping review. DATA SOURCES: Eight databases (Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, Embase, ProQuest, Psychological Information Database, PubMed, Scopus and Web of Science) were searched. Reference lists of relevant social participation reviews were also considered. METHODS: This study applied a five-stage methodological framework. A narrative synthesis summarized social participation classification and activities and their associations with health outcomes among older adults (≥65 years) living at home, in the community or in nursing residences. RESULTS: Forty-two articles published between 1975 and 2022 were selected. Four classification criteria of social participation were extracted and summarized from these studies. Based on the depth and breadth of social interactions, this review proposed a four-level classification schema. A lower risk of mortality and less visual impairment were associated with participation in level-one, level-three or level-four activities, whereas less depression, less pain and better cognitive function were linked to participation in level-three or level-four activities. CONCLUSION: Future studies should provide a clear definition, establish classification criteria for participation and properly select activity forms while considering both subjective and objective dimensions. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The results could provide data for designing targeted social participation interventions to improve specific health outcomes among older adults. IMPACT: This review could help researchers examine the role of social participation activities in specific health outcomes. Moreover, a proposed classification of social participation activities would benefit researchers and community nurses in discerning the similarities and differences among activities. REPORTING METHOD: This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews guideline. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

The Mediating Effect of Social Participation Restriction on the Association Between Role Overload and Mental Health Among Caregivers of Older Adults with Dementia.

Caregivers of older adults with dementia (dementia caregivers) often experience high role overload (i.e., feeling overwhelmed by caregiving demands that exceed available resources), which can take a toll on their mental health. Moreover, dementia caregiving can restrict caregivers' participation in valued social activities. This study aims to examine the mediating effect of social participation restriction on the relationship between role overload and mental health among dementia caregivers. A total of 894 dementia caregivers (mean age = 61.77) were selected from the National Study of Caregiving. The sample was predominantly women (64%) and White (78%). Path analysis shows that social participation restriction partially mediated the associations between (1) role overload and psychological distress (indirect effect ß = .08, p < .001) and (2) role overload and psychological wellbeing (indirect effect ß = -.05, p < .05). Interventions targeting coping strategies and healthcare-recreation programs are needed to improve social participation among dementia caregivers.

Mediating effect of social support on the relationship between social activity and depressive symptoms among older widows in Taiwan.

The purpose of this study was to investigate the mediating effect of social support on the relationship between social activity and depressive symptoms among older widows in Taiwan. A cross-sectional study was conducted that recruited 256 older widows in southern Taiwan. Data were collected on demographic characteristics, self-rated health, instrumental activities of daily living, social activity, social support, and depression. Multiple linear regressions performed examined whether social activities and social support were significantly associated with depressive symptoms and which types of social activity were significantly related to social support and depressive symptoms. Mediation analyses performed tested the mediation effect of social support between the number of different types of social activities performed (termed "number of activities" in this study) and depression. Overall, 17.2% of the participants reported having at least two depressive symptoms. The total effect of the number of activities on depressive symptoms was significant (p < .001). The direct pathway from the number of activities to depressive symptoms remained significant (p < .001), and the mediation pathway (from the number of activities to depressive symptoms through social support) was also significant (Bootstrap CI = -.072, -.003). These findings demonstrated that older widows had more social support when they participated in more social activities, which could then decrease depressive symptoms. In addition, informal community group activities and religious group activities were the most effective at increasing social support and reducing depressive symptoms among the older Taiwanese widows.

Development of a weighted scoring model for social activities to predict disability incidents among older Japanese adults.

BACKGROUND: Social activities contribute to health improvements in older adults, but methods for evaluating these activities are not yet established. We developed a scoring model for social activity, weighted by specific activities, to assess the association between disability incidence in older adults and social activities. METHODS: Data were obtained from Japan's National Center for Geriatrics and Gerontology Study of Geriatric Syndromes (NCGG-SGS). Social activity was evaluated across 16 domains. Disability was determined using data extracted from Japan's long-term care insurance system. RESULTS: Data from 4998 older adults were analyzed; among them, 422 (8.4 %) developed a disability within 35 months (Interquartile range: 32-39). The Cox proportional hazards model was used to assess 16 domains of social activity. The results yielded risk factors for disability incidence in six social activity domains: work, travel, hobbies, babysitting, family caregiving, and events. The coefficients for these activities were assigned weights of 3, 3, 2, 1, 1, and 1, respectively. The weighted social activity scoring model significantly improved the ability to predict disability incidence when the number of social activities in which individuals participated was considered (social activity score: area under the curve [AUC] 0.691, 95 % confidence interval [CI] 0.664-0.717; number of social activities: AUC 0.681, 95 % CI 0.654-0.707, P = 0.042). CONCLUSIONS: The composite score derived from the weighted social activity scoring model serves as a valuable tool due to its enhanced predictability, which complements established background factors associated with the incidence of disability in older adults.

Psychometric properties of a Turkish version of the social activities scale for community-dwelling older people requiring support.

BACKGROUND: Social activities decelerate the deterioration of mental capacity in older people and improve their physical and psychosocial health. Valid and reliable measurement tools are needed to determine the social activity status of older people and plan health services to protect their mental health. OBJECTIVE: This study aimed to adapt the Social Activities Scale for Community-Dwelling Older People Requiring Support (SASOS) into Turkish. METHODS: This methodological study was conducted in Northern Cyprus between January and June 2022. Convenience sampling was used to recruit 155 community-dwelling older people who needed support. Expert opinion, item-content validity index, and scale-content validity index were used to evaluate content validity. Internal consistency and test-retest reliability tests were used to evaluate reliability. Exploratory factor analysis was used to evaluate construct validity. The Loneliness Scale for Elderly was used to evaluate concurrent validity. RESULTS: The Cronbach's alpha of SASOS was 0.90. Additionally, correlation coefficients of all items ranged between 0.61 and 0.79. Exploratory factor analysis revealed a three-factor structure. 'Interactions with friends and neighbors' was the factor that explained the highest variance (46%). There was a negative, weak, and statistically significant relationship between the scores obtained from the social loneliness subscale of LSE and all three subscales of SASOS. CONCLUSIONS: The Turkish version of SASOS is a valid, reliable instrument to evaluate social activities in community-dwelling older people who needed support. IMPLICATIONS FOR PRACTICE: The SASOS has been identified as a valuable measure for assessing the social support needs of older individuals. It serves as a guide for both planning and evaluating interventions to enhance their health.

Psychiatric Characteristics, Symptoms of Insomnia and Depression, Emotion Regulation, and Social Activity among Swiss Medical Students.

Background: Almost by default, young adult students are at increased risk of suffering from mental health issues, and this holds particularly true for medical students. Indeed, compared to the general population and non-medical students, medical students report higher scores for symptoms of depression. For Swiss medical students, research on the associations between psychiatric characteristics and symptoms of depression and insomnia, including cognitive-emotional processes and social activity, has been lacking so far. Given this, the aims of the present study were to relate self-declared psychiatric characteristics to symptoms of depression, insomnia, emotion regulation, and social activity. Methods: A total of 575 medical students (mean age: 22.4 years; 68.9% females) completed an online survey covering sociodemographic information (age and gender), study context (year of study), self-declared psychiatric characteristics and symptoms of depression, insomnia, emotion regulation (cognitive reappraisal vs. emotion suppression), and social activity. Data on insomnia sum scores and categories of historical samples (862 non-medical students and 533 police and emergency response service officers) were used for comparison. Results: Of the 575 participants, 190 participants (33%) self-declared psychiatric issues, such as major depressive disorder; anxiety disorders, including PTSD and adjustment disorders; eating disorders; ADHD; or a combination of such psychiatric issues. Self-reporting a psychiatric issue was related to higher symptoms of depression and insomnia and lower symptoms of social activity and cognitive reappraisal (always with significant p-values and medium effect sizes). Compared to historical data for non-medical students and police and emergency response service officers, medical students reported higher insomnia scores. In a regression model, current self-declared psychiatric issues, female gender, higher scores for insomnia, and lower scores for social activity were associated with higher scores for depression. Conclusions: Among a sample of Swiss medical students, the occurrence of self-declared psychiatric issues was associated with higher scores for depression and insomnia and lower cognitive reappraisal and social activity. Further, insomnia scores and insomnia categories were higher when compared to non-medical students and to police and emergency response service officers. The data suggest that medical schools might introduce specifically tailored intervention and support programs to mitigate medical students' mental health issues. This holds particularly true for insomnia, as standardized and online-delivered treatment programs for insomnia (eCBTi) are available.

Social participation mediates the relationship between self-efficacy and loneliness among people with stroke during COVID-19: a cross-sectional study.

BACKGROUND: People post-stroke experience increased loneliness, compared to their healthy peers and loneliness may have increased during COVID due to social distancing. How social distancing affected loneliness among people after stroke is unknown. Bandura's self-efficacy theory suggests that self-efficacy may be a critical component affecting individuals' emotions, behaviors, attitudes, and interpretation of everyday situations. Additionally, previous studies indicate that self-efficacy is associated with both loneliness and social participation. This study investigates relationships among self-efficacy, social participation, and loneliness in people with stroke. OBJECTIVES: Determine how social participation affects the relationship between self-efficacy and loneliness in people with stroke during the COVID-19 pandemic. METHODS: 44 participants were community-dwelling individuals, ≥ 6 months post-stroke who participated in a 2-hour phone interview. A regression-based mediation analysis was conducted using these measures: Participation Strategies Self-Efficacy Scale, Activity Card Sort for social participation, and UCLA Loneliness Scale for loneliness. RESULTS: The total effect of self-efficacy on loneliness was significant (b = -0.36, p = .01). However, social participation fully mediated the relationship between self-efficacy and loneliness (indirect effect, b = -0.11, 95% CI [-0.24, -0.01]; direct effect, b = -0.25, 95% CI [-0.03, 0]). CONCLUSIONS: Self-efficacy is associated with both social participation and loneliness in people with stroke in this cross-sectional study. Mediation analysis findings suggest that interventions focused on increasing social participation may prevent or potentially alleviate loneliness in people with stroke who have low self-efficacy.

Association of increased participation in social activity in later life with risk of all-cause mortality and heart diseases in older people: results from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).

Background: Previous studies have shown social activity is associated with reduced risk of health outcomes. However, among older people (≥65 years) who were socially inactive at baseline, limited study explored whether increased participation in social activity in later life was associated with reduced risk of health outcomes; therefore, using the data from the Chinese Longitudinal Healthy Longevity Survey, the study was performed. Methods: The study outcomes were 10-year all-cause mortality (sample number = 9,984) and 10-year heart diseases (sample number = 7,496). The exposure was the change of social activity frequency. Cox regression analysis was used for data analysis. Results: During the follow-up, there were 6,407 all-cause mortalities and 1,035 heart diseases, respectively. Kaplan-Meier analysis demonstrated that cumulative incidences of all-cause mortality were significantly lower in participants with changes into more frequent social activity (log-rank p < 0.001), while no significant difference was observed for heart diseases (log-rank p = 0.330). Compared with the subgroup who never participated in social activity at baseline, adjusted HRs of all-cause mortality were 0.79 (95% CI: 0.70-0.90, p < 0.001), 0.78 (95% CI: 0.63-0.96, p = 0.019), 0.74 (0.59-0.92, p = 0.006), and 0.70 (95% CI: 0.56-0.88, p = 0.002) for the subgroup of switching to sometimes, the subgroup of switching to once a month, the subgroup of switching to once a week, and the subgroup of switching to everyday, respectively. The corresponding HRs of heart diseases were 0.83 (95% CI: 0.65-1.08, p = 0.170), 0.82 (95% CI: 0.51-1.31, p = 0.412), 0.91 (0.58-1.42, p = 0.675) and 0.75 (95% CI: 0.47-1.20, p = 0.227), respectively. Stratified and sensitivity analyses revealed similar results. Conclusion: Among older people who never participated in social activity, increased participation in social activity in later life was associated with reduced risk of all-cause mortality, but was not associated with reduced risk of heart diseases.

Effect of Early Rehabilitation Services After Discharge on Social Activity Among Chronic Stroke Survivors: A Multicenter Prospective Study.

BACKGROUND: Social inactivity after a stroke leads to adverse outcomes, making social activity after discharge important for chronic stroke survivors. This study aimed to investigate the effects of early rehabilitation services after discharge on social activity among chronic stroke survivors. METHODS: The participants were prospectively recruited from 3 convalescent hospitals. Receipt of early rehabilitation services after discharge for chronic stroke survivors was defined as the utilization of day care or home-based rehabilitation services by the Japanese long-term care insurance system. Social activity was assessed using the Frenchay Activities Index (FAI) premorbid and at 3, 6, and 12 months after discharge. In this study, the outcome was defined as the change in the FAI score from 3 to 12 months after discharge. Multivariate regression analysis was performed to examine the effect of access to rehabilitation on changes in FAI. RESULTS: Ninety stroke survivors (age 67.2±11.6 years, 52 male) were enrolled. The FAI showed improvements by 27.4% and 1.4% from 3 to 12 months after discharge in the rehabilitation and nonrehabilitation groups, respectively. Multivariate regression analysis showed that access to rehabilitation after discharge was positively associated with the FAI change from 3 to 12 months after discharge (B=30.3, ß=0.38, 95% confidence interval=11.13-49.47, P=0.002). CONCLUSIONS: Early rehabilitation services after discharge were significantly associated with increased social activity.

The association between intolerance of uncertainty and depressive symptoms during COVID-19 in New York, USA.

BACKGROUND: Coronavirus Disease 2019 (COVID-19), a highly contagious respiratory illnesses, has globally impacted mental health. This study aims to investigate the association between intolerance of uncertainty and depressive symptoms during the pandemic in New York, USA, considering COVID-19-related worries as modifiers and mediators. METHOD: 1227 participants from three ongoing cohort studies, originally centered on trauma-exposed children and adolescents, provided data via questionnaires and telephone interviews across three waves. We used multivariable logistic and linear regression models to investigate the intolerance of uncertainty-depressive symptoms relationship, while adjusting for potential confounders and assessing the modification and mediation effects of Covid-19 related worries. RESULTS: Depressive symptoms prevalence was 18 %, 12 %, and 9 % at waves 0, 1, and 2 respectively. Strong positive associations were observed between intolerance of uncertainty above the median and depressive symptoms which remained significant after adjusting for potential confounders. Odds ratios were 2.14 (95 % CI: 1.54-2.99) and 4.50 (95 % CI: 2.67-7.93) for intolerance of uncertainty-depressive symptoms association at wave 0 and 1 respectively, and 3.22 (95 % CI: 1.68-6.63) for intolerance of uncertainty at wave 1 and depressive symptoms at wave 2. There was evidence of partial mediation by worries (12-37 %), but no evidence of a moderating effect. LIMITATION: It includes study's methodology, including self-report measures, remote data collection, and uncontrolled variables like anxiety and COVID-19 perspectives. CONCLUSION: The findings emphasize the importance of evidence-based strategies for tackling intolerance of uncertainty during pandemics, particularly in managing long COVID. Collaborative efforts between policymakers and clinicians are essential in this endeavor.

Social activities and depressive symptoms among migrant middle-aged and older adults in China: a network analysis.

Background: This study investigated the central symptom within the depression network and examined the relationship between social activities and depressive symptoms among migrant middle-aged and older adults in China. Methods: We analyzed data from 1,926 migrants aged 45 and older, derived from the 2018 China Health and Retirement Longitudinal Study (CHARLS). Using network analysis, we identified the central depressive symptom and assessed the association between various social activities and depressive symptoms. Results: Network analysis revealed that depressed mood was the most central symptom. Regarding mitigation of depressive symptoms, informal social activities predominantly influenced positive emotions and somatic symptoms. Formal activities were mainly revealed through positive emotions. Solitary activities were manifested primarily through positive emotions and somatic symptoms. In addition, informal and solitary activities showed a stronger correlation with the alleviation of depressive symptoms compared to formal activities. Conclusion: The findings underscore the importance of addressing depressed mood in treating depression among migrant middle-aged and older adults. Recognizing the differential impacts of various social activities can aid in the development of customized prevention and intervention strategies aimed at enhancing the mental well-being of this demographic in China.

Multimodal lifestyle engagement patterns support cognitive stability beyond neuropathological burden.

BACKGROUND: Modifiable lifestyle behaviors account for a large proportion of dementia risk. However, the combined contributions of multidomain lifestyle patterns to cognitive aging are poorly understood, as most studies have examined individual lifestyle behaviors in isolation and without neuropathological characterization. This study examined data-driven patterns of lifestyle behaviors across multiple domains among older adults and tested their associations with disease-specific neuropathological burden and cognitive decline. METHODS: Participants included 2059 older adults enrolled in the longitudinal Memory and Aging Project (MAP) at the Rush Alzheimer's Disease Center; none of whom had dementia at baseline (73% no cognitive impairment (NCI), 27% mild cognitive impairment [MCI]). All participants completed cognitive testing annually. Lifestyle factors were measured during at least one visit and included (1) actigraphy-measured physical activity, as well as self-reported (2) sleep quality, (3) life space, (4) cognitive activities, (5) social activities, and (6) social network. A subset of participants (n = 791) had autopsy data for which burden of Alzheimer's disease (AD), cerebrovascular disease (CVD), Lewy body disease, and hippocampal sclerosis/TDP-43 was measured. Latent profile analysis across all 2059 participants identified distinct subgroups (i.e., classes) of lifestyle patterns. Linear mixed-effects models examined relationships between lifestyle classes and global cognitive trajectories, with and without covarying for all neuropathologies. Classes were also compared on rates of incident MCI/dementia. RESULTS: Five classes were identified: Class 1Low Life Space (lowest lifestyle engagement), Class 2PA (high physical activity), Class 3Low Avg (low to average lifestyle engagement), Class 4Balanced (high average lifestyle engagement), and Class 5Social (large social network). Classes 4Balanced and 5Social had the lowest AD burden, and Class 2PA had the lowest CVD burden. Classes 2-5 had significantly less steep global cognitive decline compared to Class 1Low Life Space, with comparable effect sizes before and after covarying for neuropathological burden. Classes 4Balanced and 5Social exhibited the lowest rates of incident MCI/dementia. CONCLUSIONS: Lifestyle behavior patterns among older adults account for differential rates of cognitive decline and clinical progression. Those with at least average engagement across all lifestyle domains exhibit greater cognitive stability after adjustment for neuropathology, highlighting the importance of engagement in multiple healthy lifestyle behaviors for later life cognitive health.