Skip to main content
Download PDF

The mediating role of children’s intergenerational support in association between grandparenting and cognitive function among middle-aged and older Chinese: findings from the CHARLS cohort study

BMC Public Health volume 24, Article number: 597 (2024) Cite this article

Abstract

Objectives

With the world’s population increasing in age, there has been a significant rise in the prevalence of cognitive impairment and dementia among individuals. This study aims to investigate the association between grandparenting and cognitive function among middle-aged and older Chinese using data from 2011 to 2018 China Health and Retirement Longitudinal Study (CHARLS). Additionally, the study seeks to explore the potential mediating effect of intergenerational support from children on this relationship, using data from the CHARLS 2011 database.

Methods

5254 participants were recruited at the baseline survey in CHARLS 2011. Subsequently, a follow-up survey was conducted over 8 years, from CHARLS 2011 to 2018, with 1472 individuals completing the follow-up survey. The CHARLS included surveys on grandparenting and cognitive assessments. Grandparenting was categorized as yes and no. The assessment of cognitive function involved the evaluation of episodic memory and mental intactness. The present study used cross-sectional and longitudinal analyses to examine the relationship between grandparenting and cognitive function. The bootstrap method assessed the mediating effect of children’s intergenerational support.

Results

The results of both cross-sectional and longitudinal studies indicated a positive association between grandparenting and cognitive function in middle-aged and older Chinese (B = 0.138, p < 0.05; B = 0.218, p < 0.05). Children’s emotional and economic support played intermediary roles between grandparenting and cognitive function.

Conclusion

The results emphasized the significance of policymakers considering the consequences of intergenerational care and family support when formulating and executing social service policies targeted at the middle-aged and older population in China.

Peer Review reports

Introduction

As the world’s population increases in age [1], there has been a significant rise in the prevalence of cognitive impairment and dementia among individuals [2]. Worldwide, around 55 million people live with dementia, which is expected to rise to 78 million in 2030 and 139 million in 2050 [3]. It has physical, psychological, social, and economic impacts, not only for people living with dementia but also for their caregivers, families, and society at large [4,5,6]. Currently, there is no effective treatment for cognitive impairment or dementia [7]. Cognitive impairment and dementia have become significant and increased global health challenges [8]. An urgent need is to find a widespread and cost-effective way to address this issue. In many developing countries, family support remains the primary source of care and support for older people [9]. Especially in China, family care for older adults has always been the most crucial way of supporting the older adults [10]. Hence, it is imperative to reevaluate the significance and role of the family unit and offer governmental assistance to address the requirements of the older population in China effectively.

Intergenerational care is a significant mode of engagement in family support of middle-aged and older adults in China [10]. As for the research on the relationship between intergenerational care and middle-aged and older people, most scholars adopt role strain theory or role enhancement theory to explore the impact of intergenerational care on the cognitive function of middle-aged and older people. According to the role enhancement theory, individuals can achieve social integration and self-fulfillment through engaging in multiple roles, thus positively impacting the individual [11, 12]. Caring for grandchildren enables grandparents to take on more social roles, increasing the interaction between middle-aged and older people and their family members, reducing their loneliness [13], improving their social integration, and bringing higher life satisfaction and self-efficacy [14]. Many studies from Western countries have provided evidence of the positive impact of caring for grandchildren on their cognitive function [15,16,17,18]. Moreover, a longitudinal study of older Koreans found that caring for grandchildren could improve global cognitive functioning scores by 30.05% [19]. According to a cross-sectional study of 7704 Chinese adults aged ≥ 45 years from the China Health and Retirement Longitudinal Study (CHARLS), providing moderate, not regular grandparenting or caring for one grandchild was more positively associated with cognitive function [20]. Wang and Zhang also noted that the positive impact of intergenerational care on cognitive function in middle-aged and older adults is more pronounced in men than in women [21]. Additionally, a study based on “the well-being of elderly in Anhui province” 2001–2012 longitudinal survey exploring the impact of providing intergenerational care on grandparents’ cognitive function trajectories, the finding shows that the provision of high-intensity intergenerational care had a significant positive effect on men’s cognitive function [22]. Nevertheless, role strain theory suggests that when role obligations exceed the physical and mental capacity of the individual, it will increase role strain, which is harmful to health [23]. Caring for grandchildren increases the physical burden and reduces self-care in older adults, resulting in cognitive decline [24]. Arpino and Bordone found that providing intensive care for grandchildren harms cognition [25]. Findings from a longitudinal prospective study of 186 Australian women from the Women’s Healthy Aging Project (WHAP) demonstrated that taking care of grandchildren five days a week or more can harm cognitive function [24]. Possible reasons for the mixed results include different analytical strategies used in the statistical analyses, different intensities of care, and socio-cultural contexts [26]. Research on how caring for grandchildren affects grandparents’ cognitive function in China is limited in the literature. Existing studies focus on cross-sectional data or regional data for a particular area for empirical analyses [20,21,22], and their results may be biased by reverse causality and simultaneity bias or suffer from the disadvantage of being under-represented. Therefore, this study uses longitudinal and large-scale national data to examine the effects of caring for grandchildren on grandparents’ cognitive function in China, thus mitigating the bias caused by the endogeneity of reverse causality and expanding previous studies focusing on cross-sectional or specific regional data.

In China’s aging society and the limited availability of long-term care services for older individuals [27], implementing intergenerational care programs enhances interaction between older adults and their families. Intergenerational support from their offspring is crucial for encouraging active aging among older individuals [28]. Empirical evidence suggests that intergenerational support from adult children serves as a significant mediator in the relationship between changes in the social dimension (such as social support, social interaction, family adaptability, cohesion, and interactions with family and friends) [29] and the physical and mental well-being of older individuals [30, 31]. According to intergenerational exchange theory, caring for grandchildren increases the likelihood of older people receiving more intergenerational support from their adult children [32]. The data from Class 2012 suggested that caring for grandchildren can significantly increase the financial support and the frequency of household work and visits by adult children [33]. Some studies have indicated that emotional and financial support from adult children could reduce the risk of cognitive decline in older adults [30, 34]. Moreover, most studies only explored the direct relationship between caring for grandchildren and cognitive function [20,21,22], and did not study the underlying mechanism. This study uses children’s intergenerational support as the intermediary variable to conduct path analysis to explore further the mechanisms underlying the effects of grandparenting on cognitive function in middle-aged and older adults.

Given this, we aimed to conduct a longitudinal study using data from 2011 to 2018 China Health and Retirement Longitudinal Study (CHARLS) to examine the relationship between grandparenting and cognitive function of middle-aged and older Chinese. Additionally, the study seeks to explore the potential mediating effect of intergenerational support from children on this relationship, using data from the CHARLS 2011 database. Specifically, we aimed to investigate the following three hypotheses. Hypothesis 1: We hypothesized that grandparenting positively affects the cognitive function of middle-aged and older Chinese. Hypothesis 2: We hypothesized that grandparenting negatively affects the cognitive function of middle-aged and older Chinese. Hypothesis 3: Children’s intergenerational support, including emotional and financial support, may mediate the relationship between grandparenting and cognitive function among middle-aged and older Chinese.

Methods

Participants and setting

Data are extracted from the China Health and Retirement Longitudinal Study (CHARLS), an ongoing nationally representative survey in China. The CHARLS was conducted in 2011 (wave 1) and includes 17,705 Chinese residents aged 45 and over from 28 provinces. The sampling technique employed for participant selection was a multistage probability-proportional-to-size (PPS) approach. The CHARLS assessments include community residents’ social, economic, and health circumstances. Consequently, three subsequent assessments were conducted in 2013 (Waves 2), 2015 (Waves 3), and 2018 (Waves 4). The CHARLS survey has obtained ethical approval from the Ethical Review Committee of Beijing University, and all the respondents have signed informed consent forms [35].

The present analysis utilizes data from four waves (2011, 2013, 2015, and 2018) of the China Health Retirement Longitudinal Study (CHARLS). We restrict individuals who met any of the following criteria at baseline (CHARLS 2011): (1) age ≥ 45 years at baseline; (2) complete the questionnaire about grandparenting; (3) complete cognitive assessments; (4) they have no self-reported diagnosis of dementia or Parkinson’s disease; (5) we exclude individuals have cognitive impairment with baseline cognitive scores < 5 points [1.5 SD below its mean] [36, 37]. Furthermore, we eliminated participants who did not have follow-up data from Wave 2 to Wave 4. A total of 5254 participants completed the baseline survey, and 1472 individuals completed the follow-up survey over eight years (see Fig. 1).

Fig. 1
figure 1

Flowchart of participant selection from the China Health and Retirement Longitudinal Study (CHARLS)

Full size image

Measures

Grandparenting

The following question is used to measure grandparenting in the CHARLS questionnaire: During last year, did you spend time taking care of your grandchildren? We allocated 1 to the respondents who answered “yes” and 0 to those who answered “no.”

Cognitive function

According to previous studies [36, 38], cognitive function is measured by two dimensions: episodic memory and mental intactness. Episodic memory is assessed using word recall tests. In the word recall tests, examiners read a list of 10 Chinese nouns, and respondents are instructed to repeat the words in any order immediately (immediate recall) and to recall the same list of words 4 min later (delayed recall). The episodic memory score is calculated as the average of the immediate and delayed recall scores, ranging from 0 to 10. Mental intactness is evaluated by ten items from the Telephone Interview of Cognitive Status test (TICS-10) [39] and a pentagon-drawing test. In CHARLS, mental status questions include serial subtraction of 7 from 100 (up to 5 times), date (month, day, year), day of the week, season, and intersecting pentagon copying test for 11 points. Total cognitive scores are calculated as the sum of episodic memory and mental intactness scores and range from 0 to 21, with higher scores indicating better cognitive function [40].

Children’s intergenerational support

Children’s intergenerational support is measured from emotional and financial support [32]. In CHARLS, children’s economic support is measured by asking the respondent about the total amount of money and goods received from children in the past year. In order to avoid the influence of extreme values, the value of this variable is added"1” and then logarithm (that is, ln(x + 1)) in the empirical analysis of this paper. According to the CHARLS questionnaire, children’s emotional support is measured by the frequency of contact with parents: “How often do you communicate with children you do not live with?” According to a previous study [32], the ten options of the questionnaire are reclassified into five options, which are “hardly,” “seldom,” “almost monthly,” “almost weekly,” and “almost every day,” and assigned a value of 0–4 in turn. In addition, we assign a value of 5 if respondents are living with their children. The total contact frequency score is 5, with higher scores indicating higher contact frequency with their children.

Covariates

The socio-demographic information is obtained from the baseline survey, including age (≥ 45 years), gender (female = 0, male = 1), education level (illiterate = 0; primary school = 1; middle school = 2; high school or above = 3), residence (urban = 0; rural = 1). Activities of daily living (ADLs) are measured by whether the respondent has difficulty in dressing, bathing and showering, eating, getting in and out of bed, using the toilet, and controlling urination and defecation. As long as one item is difficult, it is scored 1, and all six items with no difficulty are counted as 0. Depressive symptoms are measured by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D), which has been validated and widely used among Chinese adults [41]. The CESD-10 consists of 10 items: (1) felt depressed, (2) bothered by little things, (3) had trouble concentrating, (4) sleep was restless, (5) everything was an effort, (6) felt hopeful, (7) felt happy, (8) felt fearful, (9) could not get going, and (10) felt lonely. Each item uses a four-point Likert scale. The four options are “rarely or none of the time,” “some or a little of the time,” “occasionally or a moderate amount of the time, “and “most or all of the time.” Negative symptoms are assigned 0, 1, 2, and 3. On the contrary, two positive symptoms take values of 3, 2, 1, and 0. The total score on the scale is between 0 and 30 points, with the higher scores indicating more depressive symptoms.

Statistical analysis

Descriptive statistics are used to present the baseline characteristics of the enrolled participants. Continuous variables are expressed using mean and standard deviation (SD), while percentages are used for categorical variables. Chi-square tests and independent sample T-test are performed to compare the differences between participants with and without grandchildren caregiving at the baseline survey. The Kruskal-Wallis test is performed to compare the cognitive function differences among four data waves.

In this study, we estimate two regression models: cross-sectional and 8-year follow-up models. Multivariate linear regression analysis is performed in the cross-sectional model. The generalized linear mixed model (GLMM) provides a valuable approach for analyzing longitudinal data in an 8-year follow-up model [42].

The PROCESS macro for SPSS 25 is used to conduct the mediation analysis to investigate whether children’s intergenerational support mediates the effect of grandparenting on cognitive function at baseline. The mediating effect is tested using a bootstrap estimation approach with 5000 repetitions. The indirect effect is significant when the 95% CI does not contain 0.

All statistical analyses are performed with the IBM SPSS Statistics version 25. P < 0.05 is statistically significant.

Results

Baseline characteristics

Table 1 shows the baseline characteristics of the 5254 participants. The mean (SD) age at baseline was 58.88 (7.78) years. The average total cognitive score was 11.32 (3.37), and the average for depressive symptoms was 8.46 (6.25). Of all participants, most of them lived in rural areas (79.0%), had a primary school educational level (47.2%), had no difficulty in activities of daily living (85.6%), and had weekly contact with children (36.5%). For the entire sample, 49.5% of participants were involved in taking care of grandchildren. Moreover, there was a significant difference in socio-demographic characteristics, cognitive function, depressive symptoms, ADLs, and contact frequency with children between non-caregivers and caregivers (P < 0.05). Compared with participants who did not provide grandchildren care, those who cared for grandchildren had lower depressive symptoms scores and higher total cognitive scores.

Table 1 Baseline characteristics of participants
Full size table

Table 2 shows a significant difference in cognitive function among four waves. The mean score of participants’ cognitive function was 11.37(3.46), 11.17(3.79), 10.68(3.93), and 10.80(4.80) during wave 1,2,3, and 4, respectively.

Table 2 Descriptive statistics for cognitive function scores from 2011 to 2018 among middle-aged and older adults in China (N = 1427)
Full size table

Table 3 reports the results of cross-sectional and 8-year follow-up models of the relationship between grandparenting and cognitive function of middle-aged and older adults. As shown in model 1, the results of the cross-sectional model showed that grandparenting had a significant positive association with the cognitive function of middle-aged and older adults (B = 0.138, p < 0.05). The result of the 8-year follow-up model was consistent with the cross-sectional model, suggesting a favorable cognition impact of grandchildren care (B = 0.218, p < 0.05). In addition, other control variables also had a significant impact on the cognitive function. Children’s emotional and economic support and educational level significantly positively affected the cognitive function of middle-aged and older adults. In contrast, rural residents, ADLs and depressive symptoms negatively affected the cognitive function of middle-aged and older adults.

Table 3 Association between grandparenting and cognitive function in middle-aged and older adults
Full size table

Mediation effect test

Table 4 provides the results of mediation analyses. Figure 2 demonstrates the model process of children’s intergenerational support mediated the relationship of grandparenting with the cognitive function of middle-aged and older adults. As shown in Table 4, model 1, the upper and lower bounds of the bootstrap 95% confidence interval of the children’s emotional support’s indirect effect did not contain 0, so it was considered that there was a mediating effect [43]. Similar results were observed for model 2, the confidence interval of the children’s economic support’s indirect effect did not contain 0, and there was also a mediating effect.

For Fig. 2, model 1, after controlling for age, gender, and other potential confounders, path a showed that grandparenting had a significant positive effect on children’s emotional support (B = 0.275, p < 0.001). Path b showed that children’s emotional support significantly improved cognitive function (B = 0.100, p < 0.01). Path c was the total effect of grandparenting responding primarily to cognition (B = 0.196, p < 0.05), and c’ displayed the positive effect of grandparenting on cognitive function, including the mediating children’s emotional support (B = 0.169, p < 0.05). The mediating effect (indirect effect, ab = c–c’) of children’s emotional support was 0.027.

As shown in Fig. 2, model 2, path a showed that grandparenting had a significant positive effect on children’s economic support (B = 0.429, p < 0.001). Path b showed that children’s economic support significantly improved cognitive function (B = 0.028, p < 0.05). Path c represented the link between grandparenting and cognitive function (total effect). When the children’s economic support is included as an intermediary variable in the model, the coefficient of total effect was reduced to c’ (direct effect). The mediating effect (indirect effect) of children’s economic support was 0.012.

Fig. 2
figure 2

The conceptional framework of the mediation models

Note: All models were adjusted for age, gender, educational level, residence, depressive symptoms, and ADLs

* p < 0.05, ** p < 0.01, *** p < 0.001

Full size image
Table 4 Analysis of mediation effect
Full size table

Discussion

This study examined how grandparents’ cognitive function was associated with grandparenting using a nationwide longitudinal survey in China. The results suggested that grandparenting had a beneficial effect on grandparents’ cognition. Moreover, children’s intergenerational support mediated the relationship between grandparenting and cognitive function among middle-aged and older Chinese.

In this study, the finding on the positive correlation between grandparenting and cognitive function among middle-aged and older adults is consistent with the previous study and supports the role enhancement theory. Hypothesis 1 was verified. As older people age and lose their previous social roles, caring for grandchildren becomes vital compensation for social role deficits in old age [10]. The social role of taking care of grandchildren increases opportunities for interaction with grandchildren, alleviates emotional deficits in middle-aged and older adults, and improves well-being, which may mitigate depression-related effects and contribute to maintaining cognitive function status [44, 45]. Moreover, caring for grandchildren is an essential form of social engagement [17]. Providing care for grandchildren can enhance grandparents’ daily activities, such as engaging in a wider variety of activities with grandchildren and taking on the responsibility of caring for grandchildren’s daily needs, making them feel youthful and energetic, thereby enhancing social participation and benefiting their cognitive function [46,47,48]. In addition, caring for grandchildren is a combination of physical and mental work, such as assisting with school or homework, instructing and teaching grandchildren skills, which helps to enhance their mental stimulation by exercising their cognitive skills such as learning, thinking, and reasoning, thus improving cognitive function [49, 50].

Children’s intergenerational support is significantly positively correlated with the cognitive function of middle-aged and older adults, consistent with the results of previous studies [30, 34]. This study showed that the children’s intergenerational support mediated the relationship between grandparenting and cognitive function of middle-aged and older adults. Caring for grandchildren indirectly affects cognitive function in middle-aged and older adults by obtaining intergenerational support from children. Hypothesis 3 was verified. Previous research has found that increasing communication between two generations helps older adults better adjust to stressful events, reduces the risks of depression, and improves their cognitive function [30, 51, 52]. Children’s financial support will be helpful to relieve the stress of financial hardship and enhance the quality of life of older adults, thereby mitigating the stress-related impact on cognition [53, 54]. Caring for grandchildren is crucial to gaining intergenerational support from adult children [10]. From the perspective of intergenerational exchange, older parents work very hard to care for their grandchildren, and their adult children rightly provide support as an exchange of resources [55]. Generally speaking, caring for grandchildren not only frees adult children from the arduous labor of caring for minor children and increases family wealth, but it also strengthens the intergenerational bond between older adults and their children, enabling older adults to receive more financial and emotional support from their adult children, which can have a positive impact on older adults and contribute to their cognitive function [30, 51,52,53,54,55]. This exchange relationship is a two-way intergenerational support between parents and children, corresponding to the intergenerational exchanges in the family in the form of “upbringing support” [56].

There is a growing trend of increased female participation in social labor, but the social support for child-rearing is seriously inadequate in China [57]. The significance and worth of intergenerational care must be considered. It is imperative for society and families to actively promote the involvement of older individuals in the care of their grandchildren. This practice reduces the caregiving burden on the parents and contributes to societal advancement. Simultaneously, adult children must provide more intergenerational assistance to the older individuals who actively care for their grandchildren to alleviate the mental and psychological burdens associated with caregiving. With calls for healthy aging, there is a need to improve the quality of intergenerational relationships and establish positive intergenerational exchange patterns. Society and families must prioritize the older population’s healthcare concerns and living requirements. In order to promote intergenerational communication, it is recommended that the government implement policies aimed at enhancing family leave provisions and allocating additional time for intergenerational interaction [52].

The present study has certain limitations. First, our measure of caring for grandchildren is a binary variable, indicating ‘yes’ or ‘no’. We do not consider the number of grandchildren cared for and the intensity of grandchild care. Secondly, this paper does not control the grandchildren’s ages due to data limitations. The care needs of grandchildren vary considerably by age [58]. Finally, cognition evaluation is subjective and unstable. There is no clinical diagnosis of cognitive impairment.

Conclusion

The results of the present study revealed that grandparenting was significantly positively related to the cognitive function of middle-aged and older Chinese, and children’s intergenerational support mediated the relationship between grandparenting and cognitive function. Therefore, policymakers must consider the consequences of intergenerational care and family support when formulating and executing social service policies targeted at the middle-aged and older population in China.

Data availability

The database (CHARLS), which is used in this paper, is publicly available.

(http://charls.pku.edu.cn/en).

References

  1. United Nations, Department of Economic and Social Affairs, Population Division. World population ageing 2015 (ST/ESA/SER.A/390) [(accessed on 14 Jul 2021)]. Available online: https://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2015_Report.pdf

  2. Mendis SB, Raymont V, Tabet N. Bilingualism: a global public health strategy for healthy cognitive aging. Front Neurol. 2021;12:512. https://doi.org/10.3389/fneur.2021.628368

    Article  Google Scholar 

  3. World Health Organization. Dementia. https://www.who.int/news-room/fact-sheets/detail/dementia. Accessed 10 Feb 2022.

  4. Cheng S. Dementia caregiver burden: a research update and critical analysis. Curr Psychiatry Rep. 2017;19(9):1–08. https://doi.org/10.1007/s11920-017-0818-2

    Article  CAS  Google Scholar 

  5. Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D. Dementia prevention, intervention, and care. Lancet. 2017;390(10113):2673–734. https://doi.org/10.1016/S0140-6736(17)31363-6

    Article  PubMed  Google Scholar 

  6. Leicht H, Heinrich S, Heider D, Bachmann C, Bickel H, van den Bussche H, et al. Net costs of dementia by disease stage. Acta Psychiatr Scand. 2011;124(5):384–95. https://doi.org/10.1111/j.1600-0447.2011.01741.x

    Article  CAS  PubMed  Google Scholar 

  7. Raina P, Santaguida P, Ismaila A, Patterson C, Cowan D, Levine M, et al. Effectiveness of cholinesterase inhibitors and memantine for treating dementia: evidence review for a clinical practice guideline. Ann Intern Med. 2008;148(5):379–97. https://doi.org/10.7326/0003-4819-148-5-200803040-00009

    Article  PubMed  Google Scholar 

  8. Nichols E, Szoeke CE, Vollset SE, Abbasi N, Abd-Allah F, Abdela J, et al. Global, regional, and national burden of Alzheimer’s disease and other dementias, 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet Neurol. 2019;18(1):88–106. https://doi.org/10.1016/S1474-4422(18)30499-X

    Article  Google Scholar 

  9. Lowenstein A, Katz R, Gur Yaish N. Reciprocity in parent–child exchange and life satisfaction among the elderly: a cross-national perspective. J Soc Issues. 2007;63(4):865–83. https://doi.org/10.1111/j.1540-4560.2007.00541.x

    Article  Google Scholar 

  10. Cheng X, Jiang Q. The impact of caring for grandchildren on grandparents’age identity: the mediation effects of intergenerational support. Popul J. 2019;41(03):63–76. https://doi.org/10.16405/j.cnki.1004-129X.2019.03.006

    Article  Google Scholar 

  11. Sieber SD. Toward a theory of role accumulation. Am Sociol Rev. 1974:567–78. https://doi.org/10.2307/2094422

  12. Moen P, Robison J, Dempster-McClain D. Caregiving and women’s well-being: a life course approach. J Health Soc Behav. 1995:259–73. https://doi.org/10.2307/2137342

  13. Mahne K, Huxhold O. Grandparenthood and subjective well-being: moderating effects of educational level. Journals Gerontol Ser B: Psychol Sci Social Sci. 2015;70(5):782–92. https://doi.org/10.1093/geronb/gbu147

    Article  Google Scholar 

  14. Choi SE, Zhang Z. Caring as curing: grandparenting and depressive symptoms in china. Soc Sci Med. 2021;289:114452. https://doi.org/10.1016/j.socscimed.2021.114452

  15. Bertrand RM, Saczynski JS, Mezzacappa C, Hulse M, Ensrud K, Fredman L. Caregiving and cognitive function in older women: evidence for the healthy caregiver hypothesis. J Aging Health. 2012;24(1):48–66. https://doi.org/10.1177/0898264311421367

    Article  PubMed  Google Scholar 

  16. Sneed RS, Schulz R. Grandparent caregiving, race, and cognitive functioning in a population-based sample of older adults. J Aging Health. 2019;31(3):415–38. https://doi.org/10.1177/0898264317733362

    Article  PubMed  Google Scholar 

  17. Burn K, Szoeke C. Is grandparenting a form of social engagement that benefits cognition in ageing? Maturitas. 2015;80(2):122–25. https://doi.org/10.1016/j.maturitas.2014.10.017

    Article  PubMed  Google Scholar 

  18. Di Gessa G, Glaser K, Tinker A. The impact of caring for grandchildren on the health of grandparents in europe: a lifecourse approach. Soc Sci Med. 2016;152:166–75. https://doi.org/10.1016/j.socscimed.2016.01.041

    Article  PubMed  Google Scholar 

  19. Ahn T, Choi KD. Grandparent caregiving and cognitive functioning among older people: evidence from Korea. Rev Econ Househ. 2019;17(2):553–86. https://doi.org/10.1007/s11150-018-9413-5

    Article  Google Scholar 

  20. Liao S, Qi L, Xiong J, Yan J, Wang R. Intergenerational ties in context: association between caring for grandchildren and cognitive function in middle-aged and older Chinese. Int J Environ Res Public Health. 2021;18(1):21. https://doi.org/10.3390/ijerph18010021

    Article  Google Scholar 

  21. Wang S, Zhang S. Influence of skip- generation care offering on cognitive function of middle aged and elderly people ——an analysis based on propensity matched technique. Popul J. 2021;43(03):60–71. https://doi.org/10.16405/j.cnki.1004-129X.2021.03.006

    Article  Google Scholar 

  22. Song L, Li L, Li S. The impact of grandchild-caring on grandparents’ cognitive functioning in rural China: a study based on the 2001–2012 longitudinal surveys. China Acad J. 2013;(6):215–37. https://doi.org/10.19934/j.cnki.shxyj.2013.06.010

  23. Goode WJ. A theory of role strain. Am Sociol Rev. 1960;483–96. https://doi.org/10.2307/2092933

  24. Burn KF, Henderson VW, Ames D, Dennerstein L, Szoeke C. Role of grandparenting in postmenopausal women’s cognitive health: results from the women’s healthy aging project. Menopause. 2014;21(10):1069–74. https://doi.org/10.1097/GME.0000000000000236

    Article  PubMed  Google Scholar 

  25. Arpino B, Bordone V. Does grandparenting pay off? The effect of child care on grandparents’ cognitive functioning. J Marriage Fam. 2014;76(2):337–51. https://doi.org/10.1111/jomf.12096

    Article  Google Scholar 

  26. Oshio T. Is caring for grandchildren good for grandparents’ health? Evidence from a fourteen-wave nationwide survey in Japan. J Epidemiol. 2022;32(8):363–69. https://doi.org/10.2188/jea.JE20200529

    Article  PubMed  PubMed Central  Google Scholar 

  27. Feng Z, Liu C, Guan X, Mor V. China’s rapidly aging population creates policy challenges in shaping a viable long-term care system. Health Aff (Millwood). 2012;31(12):2764–73. https://doi.org/10.1377/hlthaff.2012.0535

    Article  PubMed  Google Scholar 

  28. Jia Y, Ye Z. Impress of intergenerational emotional support on the depression in non-cohabiting parents. World J Clin Cases. 2019;7(21):3407. https://doi.org/10.12998/wjcc.v7.i21.3407

    Article  PubMed  PubMed Central  Google Scholar 

  29. Leroux JS, Moore S, Dubé L. Beyond the i in the obesity epidemic: a review of social relational and network interventions on obesity. J Obes. 2013;2013. https://doi.org/10.1155/2013/348249

  30. Li Y, Guo M. Filial piety matters: a study of intergenerational supports and parental health. Ssm Popul Health. 2022;18:101096. https://doi.org/10.1016/j.ssmph.2022.101096

    Article  PubMed  PubMed Central  Google Scholar 

  31. Zhou J, Mao W, Lee Y, Chi I. The impact of caring for grandchildren on grandparents’ physical health outcomes: the role of intergenerational support. Res Aging. 2017;39(5):612–34. https://doi.org/10.1177/0164027515623332

    Article  PubMed  Google Scholar 

  32. Tang S, Yang T, Ye C, Liu M, Gong Y, Yao L, et al. Research on grandchild care and depression of Chinese older adults based on CHARLS 2018: the mediating role of intergenerational support from children. BMC Public Health. 2022;22(1):1–14. https://doi.org/10.1186/s12889-022-12553-x

    Article  Google Scholar 

  33. Xu Q. More than upbringing: parents’ support and the effect on filial duty. Chin J Sociol. 2017;2:216–40. https://doi.org/10.15709/hswr.2017.37.1.216

    Article  Google Scholar 

  34. Wang P, Gao B. A longitudinal study of the effect of intergenerational support on cognitive function of rural elderly. Popul J. 2011;3:70–9. https://doi.org/10.3969/j.issn.1004-129X.2011.03.009

    Article  Google Scholar 

  35. Zhao Y, Hu Y, Smith JP, Strauss J, Yang G. Cohort profile: the China health and retirement longitudinal study (CHARLS). Int J Epidemiol. 2014;43(1):61–8. https://doi.org/10.1093/ije/dys203

    Article  PubMed  Google Scholar 

  36. Li H, Li C, Wang A, Qi Y, Feng W, Hou C, et al. Associations between social and intellectual activities with cognitive trajectories in Chinese middle-aged and older adults: a nationally representative cohort study. Alzheimers Res Ther. 2020;12(1):1–12. https://doi.org/10.1186/s13195-020-00691-6

    Article  Google Scholar 

  37. Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol. 1999;56(3):303–08. https://doi.org/10.1001/archneur.56.3.303

    Article  CAS  PubMed  Google Scholar 

  38. Xie J, Fan X, Yin P, Gu J, Yang C. Association between childhood friendship and cognitive ageing trajectory in later life: evidence from the China health and retirement longitudinal study (CHARLS). Bmc Geriatr. 2022;22(1):1–10. https://doi.org/10.1186/s12877-022-03181-6

    Article  Google Scholar 

  39. Brandt J, Spencer M, Folstein M. The telephone interview for cognitive status. Neuropsychiatry Neuropsychol Behav Neurol. 1988;1(2):111–17.

    Google Scholar 

  40. Yuan M, Xu C, Fang Y. The transitions and predictors of cognitive frailty with multi-state markov model: a cohort study. Bmc Geriatr. 2022;22(1):1–11. https://doi.org/10.1186/s12877-022-03220-2

    Article  Google Scholar 

  41. Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the ces-d. Am J Prev Med. 1994;10(2):77–84. https://doi.org/10.1016/S0749-3797(18)30622-6

    Article  CAS  PubMed  Google Scholar 

  42. Cnaan A, Laird NM, Slasor P. Using the general linear mixed model to analyse unbalanced repeated measures and longitudinal data. Stat Med. 1997;16(20):2349–80. https://doi.org/10.1002/(sici)1097-0258(19971030)16:20<2349::aid-sim667glt;3.0.co;2-e

    Article  CAS  PubMed  Google Scholar 

  43. Wen ZL, Ye BJ. Analysis of mediation effect: method and model development. Adv Psychol Sci. 2014;22(05):731–45.

    Article  Google Scholar 

  44. Lo M, Liu YH. Quality of life among older grandparent caregivers: a pilot study. J Adv Nurs. 2009;65(7):1475–84. https://doi.org/10.1111/j.1365-2648.2009.05000.x

    Article  PubMed  Google Scholar 

  45. Vinkers DJ, Gussekloo J, Stek ML, Westendorp RG, van der Mast RC. Temporal relation between depression and cognitive impairment in old age: prospective population based study. BMJ. 2004;329(7471):881. https://doi.org/10.1136/bmj.38216.604664.DE

    Article  PubMed  PubMed Central  Google Scholar 

  46. Villar F, Celdrán M, Triadó C. Grandmothers offering regular auxiliary care for their grandchildren: an expression of generativity in later life? J Women Aging. 2012;24(4):292–312. https://doi.org/10.1080/08952841.2012.708576

    Article  PubMed  Google Scholar 

  47. Fuller-Thomson E, Serbinski S, McCormack L. The rewards of caring for grandchildren: black canadian grandmothers who are custodial parents, co- parents, and extensive babysitters. GrandFamilies: The Contemporary Journal of Research, Practice and Policy. 2014;1(1):2. Available at: https://scholarworks.wmich.edu/grandfamilies/vol1/iss1/2

  48. Jendrek MP. Grandparents who parent their grandchildren: effects on lifestyle. J Marriage Fam. 1993:609–21. https://doi.org/10.2307/353342

  49. Stern Y. Cognitive reserve in ageing and alzheimer’s disease. Lancet Neurol. 2012;11(11):1006–12. https://doi.org/10.1016/S1474-4422(12)70191-6

    Article  PubMed  PubMed Central  Google Scholar 

  50. Kwok TC, Bai X, Li JC, Ho FK, Lee TM. Effectiveness of cognitive training in Chinese older people with subjective cognitive complaints: a randomized placebo-controlled trial. Int J Geriatr Psychiatry. 2013;28(2):208–15. https://doi.org/10.1002/gps.3812

    Article  PubMed  Google Scholar 

  51. Zhou A, Song Y, Li X, Hu B, Chen Y, Cui P, et al. Functional limitationand happiness among older adults: the multiple mediating role of intergenerational support and intergenerational relationship. Front Public Health. 2023;11:1249216. https://doi.org/10.3389/fpubh.2023.1249216

    Article  PubMed  PubMed Central  Google Scholar 

  52. Ranran Z, Mingyang Y, Huang L, Fang W, Baizhi G, Duanduan F et al. Effect of intergenerational exchange patterns and intergenerational relationship quality on depressive symptoms in the elderly: an empirical study on CHARLS data. Front Public Health. 2022:3624. https://doi.org/10.3389/fpubh.2022.1009781

  53. Shu Z, Xiao J, Dai X, Han Y, Liu Y. Effect of family upward intergenerational support on the health of rural elderly in China: evidence from Chinese longitudinal healthy longevity survey. PLoS ONE. 2021;16(6):e253131. https://doi.org/10.1371/journal.pone.0253131

    Article  CAS  Google Scholar 

  54. Kremen WS, Lachman ME, Pruessner JC, Sliwinski M, Wilson RS. Mechanisms of age-related cognitive change and targets for intervention: social interactions and stress. J Gerontol Biol Sci Med Sci. 2012;67(7):760–5. https://doi.org/10.1093/gerona/gls125

    Article  Google Scholar 

  55. Sun Q, Wang Y, Lu N, Lyu S. Intergenerational support and depressive symptoms among older adults in rural China: the moderating roles of age, living alone, and chronic diseases. Bmc Geriatr. 2022;22(1):1–12. https://doi.org/10.1186/s12877-021-02738-1

    Article  Google Scholar 

  56. Wang H. Caregivers being cared: care for grandchildren and support from grown-up children interact. Popul J. 2021;43:74–88. https://doi.org/10.16405/j.cnki.1004-129X.2021.04.007

    Article  Google Scholar 

  57. Chen F, Liu G, Mair CA. Intergenerational ties in context: grandparents caring for grandchildren in China. Soc Forces. 2011;90(2):571–94. https://doi.org/10.1093/sf/sor012

    Article  PubMed  PubMed Central  Google Scholar 

  58. Chen F, Liu G. The health implications of grandparents caring for grandchildren in China. Journals Gerontol Ser B: Psychol Sci Social Sci. 2012;67(1):99–112. https://doi.org/10.1093/geronb/gbr132

    Article  Google Scholar 

Download references

Acknowledgements

Thanks for all participants of the National School of Development workshop in Peking University and thanks for their efforts in the China Health and Retirement Longitudinal Study (CHARLS).

Funding

None reported.

Author information

Author notes

  1. Xuebei Hou and Yujun Luo contributed equally to this work.

Authors and Affiliations

  1. School of Nursing, Hubei University of Chinese Medicine, Wuhan, China

    Xuebei Hou, Fen Yang, Xinhong Zhu, Xiaolian Gao, Wenqiang Wang & Guiyuan Qiao

  2. Department of Tuina and Rehabilitation Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Wuhan, China

    Yujun Luo & Jing Zhou

  3. Department of Tuina and Rehabilitation Medicine, Affiliated Hospital of Hubei University of Chinese Medicine, Wuhan, China

    Yujun Luo & Jing Zhou

  4. Department of Tuina and Rehabilitation Medicine, Hubei Provincial Institute of Traditional Chinese Medicine, Wuhan, China

    Yujun Luo & Jing Zhou

  5. First Clinical Medical College, Hubei University of Chinese Medicine, Wuhan, China

    Jing Zhou

Authors
  1. Xuebei Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yujun Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fen Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xinhong Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiaolian Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wenqiang Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Guiyuan Qiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jing Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

We thank XH, YL, FY, GQ and JZ designed research and conducted research; XH and YL analyzed data and wrote the manuscript; FY, XZ, XG and WW revised the paper, JZ and GQ had primary responsibility for the final content. All authors revised it critically for important intellectual content.

Corresponding authors

Correspondence to Guiyuan Qiao or Jing Zhou.

Ethics declarations

Ethics approval and consent to participate

Ethics approval for the study was granted by the Ethical Review Committee of Peking University. The IRB approval number is IRB00001052-11015. Informed consent was obtained at the time of participation. All methods of this study were performed in accordance with the relevant guidelines and regulations. All experimental protocols were approved by Institutional Review Board at Peking University.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hou, X., Luo, Y., Yang, F. et al. The mediating role of children’s intergenerational support in association between grandparenting and cognitive function among middle-aged and older Chinese: findings from the CHARLS cohort study. BMC Public Health 24, 597 (2024). https://doi.org/10.1186/s12889-024-18106-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12889-024-18106-8

Keywords

BMC Public Health

ISSN: 1471-2458

Contact us