Social frailty as a pathway linking material precarity to cognitive impairment among older adults in Sweden, Germany and Spain: a structural equation modelling approach

OBJECTIVES: Material disadvantage and social vulnerability are key determinants of health in later life, yet their interrelationship and implications for cognitive functioning remain insufficiently understood across different welfare contexts. This study examines whether social frailty mediates the association between material precarity and cognitive impairment among older adults in three European countries with distinct welfare regimes: Sweden, Germany, and Spain. METHOD: Using longitudinal data from Waves 8 and 9 of the Survey of Health, Ageing and Retirement in Europe (SHARE), we applied structural equation modelling to examine direct and indirect pathways linking baseline material precarity and social frailty to cognitive impairment at follow-up. RESULTS: Findings reveal substantial cross-national variation. In Sweden, the association between material precarity and cognitive impairment was fully mediated by social frailty, particularly through psychological vulnerability and reduced social participation. In Germany, both direct and indirect pathways were observed, indicating partial mediation. In Spain, the association was primarily direct, with no significant mediation through social frailty. These patterns suggest that the translation of material disadvantage into cognitive risk is shaped by institutional and socio-cultural contexts, influencing whether social frailty operates as an attenuating or contributing mechanism. CONCLUSION: This study advances the conceptualization of social frailty as a context-dependent pathway linking structural inequality to cognitive outcomes. It highlights the importance of integrating material and relational vulnerability dimensions in aging research and underscores the need for tailored policy responses. While psychosocial and participatory interventions may be particularly effective in more protective welfare settings, reducing material hardship remains a priority in contexts where direct effects dominate.