Trends in Quality of Life for Older Adults With Cognitive Impairment Across Living and Care Arrangements, 2008–2022

BACKGROUND: Monitoring trends in key quality of life (QoL) indicators is crucial for effective surveillance and guiding targeted interventions to improve well-being. Few studies have examined population-level trends among older adults with cognitive impairment, particularly across different living and care arrangements. METHODS: We used repeated cross-sectional data from the 2008-2022 Health and Retirement Study (HRS) to examine trends in five key QoL indicators among a nationally representative sample of older adults with cognitive impairment, overall and by living and care arrangements. Logistic regression was applied to estimate prevalence rates of binary outcomes, and linear regression was used to estimate mean values of continuous outcomes, adjusting for covariates. RESULTS: The analytic sample included 7469 older adults with persistent cognitive impairment. Overall trends in poorer self-rated health, elevated depressive symptoms, and loneliness remained relatively stable over time. Among community-dwelling individuals, the prevalence of high life satisfaction increased (2008: 49.7%, 95% CI: 48.9%-50.6%; 2022: 55.8%, 95% CI: 54.3%-57.4%), whereas the prevalence of high purpose in life declined (2008: 55.5%, 95% CI: 54.5%-56.4%; 2022: 49.1%, 95% CI: 47%-51.2%). QoL varied across living and care arrangements. Community-dwelling individuals without Activities of Daily Living or Instrumental Activities of Daily Living (ADL/IADL) limitations consistently reported better QoL. Among those with ADL/IADL limitations, individuals without reported caregiving support had a higher prevalence of loneliness (2022: 33.2% vs. 22.6%) and a lower prevalence of high life satisfaction (2022: 41% vs. 54.2%) compared to those with caregiving support. CONCLUSIONS: Low QoL indicators were more prevalent among community-dwelling individuals with ADL/IADL limitations. These findings emphasize the importance of increasing access to home-based care and tailored interventions to enhance psychosocial well-being in community settings.