Reconfiguring social integration from family to community: the causal impact of aging in place on Chinese older adults’ cognitive health

Cognitive impairment represents one of the most pressing health challenges associated with population aging. The social integration framework locates social determinants of health across macro, meso, and micro levels, yet it remains unclear whether macro-level factors can causally shape cognitive health. We address this question using China’s 2016 aging-in-place policy. Drawing on four waves of the China Health and Retirement Longitudinal Study (2011–2018) and a Difference-in-Differences design, we estimate its causal effect on older adults’ cognitive health. Aging in place significantly improved delayed recall. The benefits were concentrated among older adults lacking children’s instrumental care or regular contact, but were attenuated among women and rural residents. These results show that community-level support can compensate for weakened or limited family support in protecting cognition. Theoretically, the study demonstrates that social integration is not merely an individual attribute but an institutionally malleable condition. It also advances understanding of the compensatory role of community support in addressing gaps in family care, whereby the state extends social integration from the family into the community to supplement family care.