Longitudinal trajectories of psychological resilience and cognitive impairment among older adults: Evidence from a national cohort study

Abstract Objectives The relationship between resilience trajectories and cognitive health is not well understood. This study aimed to identify clusters of psychological resilience trajectories in a national sample of older adults and to examine the association with cognitive impairment over time. Methods This study used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018, and 2,788 respondents were included in this prospective analysis. Using a group-based trajectory modeling approach, we identified resilience trajectory groups over a 6-year period. Cox proportional hazards models were used to assess the relationship between the resilience trajectory groups and cognitive impairment. Results Three distinct trajectories of psychological resilience, including decreasing resilience group (n=131, 4.7%), persistent middle resilience group (n=1,808, 64.8%), and persistent high resilience group (n=849, 30.5%). During the 6-year follow-up, compared to those with persistent high resilience, participants with persistent middle resilience (HR=1.40, 95%CI=1.11-1.75) and decreasing resilience (HR=2.31, 95%CI=1.65-3.23) remained consistently associated with a higher risk of cognitive impairment. The associations between resilience trajectories and cognitive impairment varied by lifestyle and health conditions. Discussion Psychological resilience is a relatively stable trait among older adults in China, with most individuals maintaining a persistently high or middle level of resilience throughout the follow-up period; however, declining psychological resilience was significantly associated with the risk of cognitive impairment. Therefore, developing targeted interventions to strengthen psychological resilience in older adults is crucial for promoting cognitive health and successful aging.