Rural-Urban Differences in Cognition: Findings From the Advanced Cognitive Training for Independent and Vital Elderly Trial

Abstract

Objectives We examined associations between three geographic areas (urban, suburban, rural) and cognition (memory, reasoning, processing speed) over a 10-year period. Methods: Data were obtained from 2539 participants in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial. Multilevel, mixed-effects linear regression was used to estimate cognitive trajectories by geographical areas over 10 years, after adjusting for social determinants of health. Results: Compared to urban and suburban participants, rural participants fared worse on all cognitive measures—memory ( B = −1.17 (0.17)), reasoning ( B = −1.55 (0.19)), and processing speed ( B = 0.76 (0.19)) across the 10-year trajectory. Across geographic areas, greater economic stability, health care access and quality, and neighborhood resources were associated with better cognition over time. Discussion: Findings highlight the importance of geographical location when examining cognition later in life. More research examining place-based life experiences is needed to make the greatest impact on geographically diverse communities.

Urbanicity and cognitive functioning in later life

“…This finding is in line with other studies examining rural–urban differences. 6 , 24 Future research should further interrogate these patterns, as this somewhat crude three‐category measure of the rural–urban continuum may downplay what are larger differences across dense, large metropolitan areas compared to sparsely populated rural areas.…”

“…5 These categories are broad, but provide nationally representative estimates, as prior studies have been limited by the use of non‐representative samples (e.g., Steinberg et al. 6 ). Recent research into disparities in aging across the rural–urban continuum highlight differences in important mechanisms such as federal policy impacts, aging and disability services organizations, and instrumental and financial support.…”

“…wileyonlinelibrary.com/journal/dad2 1 of 8 https://doi.org/10.1002/dad2.12429 scope of our study, we focus on the urbanicity of residential location, using categories of urban (metropolitan area of ≥1 million), suburban (a metropolitan area comprising = 250,000-999,999 people), and exurban (< 250,000 people or non-metropolitan). 5 These categories are broad, but provide nationally representative estimates, as prior studies have been limited by the use of non-representative samples (e.g., Steinberg et al 6 ). Recent research into disparities in aging across the rural-urban continuum highlight differences in important mechanisms such as federal policy impacts, aging and disability services organizations, and instrumental and financial support.…”

“…Because rural residents are sparse and to better narrow the scope of our study, we focus on the urbanicity of residential location, using categories of urban (metropolitan area of ≥1 million), suburban (a metropolitan area comprising = 250,000–999,999 people), and exurban (< 250,000 people or non‐metropolitan) 5 . These categories are broad, but provide nationally representative estimates, as prior studies have been limited by the use of non‐representative samples (e.g., Steinberg et al 6 …”