Background There is increasing interest in the
potential health benefits of referring older adults
to engage in community leisure activities (’social
prescribing’) to help promote healthy cognitive ageing.
However, it remains unclear whether beneficial effects
of community engagement are independent of the wellknown protective effects of broader structural, functional
and subjective social factors.
Methods We analysed data from 9550 adults aged
50+ fromthe English Longitudinal Study of Ageing, with
baseline from 2004 to 2005. We assessed associations
between different types of community engagement and
dementia incidence over a 12-year period. Specifically,
we used Cox proportional hazards models, competing
risk regressions models, and modified Fine and Gray
subdistribution hazards models while controlling for
all identified demographic, health-related, and social
covariates.
Results Community cultural engagement (eg, visiting
museums, galleries, the theatre) was associated with
a lower hazard of developing dementia in older age
independent of demographic, health-related and a
broad range of social factors, using all three statistical
approaches (fully adjusted Cox models: HR 0.58,
95%CI 0.41 to 0.80). Community group engagement
(eg, attending clubs or societies) was only associated
with dementia prior to adjustment for social factors.
Results were robust to sensitivity analyses considering
reverse causality, over-adjustment and baseline cognitive
function.
Conclusion It is not just social factors that are
associated with reduced risk of dementia onset, but
community engagement may also be protective,
particularly when relating to cultural activities. These
findings are of relevance when considering the current
interest in social prescribing to support healthy ageing