Association between any informal helping and cognitive function among older adults: a propensity score study

Objectives Whether everyday informal helping is associated with cognitive function in later life, particularly among older adults recruited from healthcare and residential care institutions, remains insufficiently characterized. This study examined the association between any informal helping and cognitive function and explored the cross-sectional statistical indirect association through depressive symptoms. Methods Using a multicenter cross-sectional design and non-probability convenience sampling, we recruited adults aged 60 years or older from seven healthcare and residential care institutions in Hubei Province, China, between June 2025 and June 2026. To reduce baseline differences between participants who did and did not provide any informal helping, seven propensity score (PS) approaches were applied, including inverse probability of treatment weighting (IPTW) and overlap weighting (OW). Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10), and an exploratory cross-sectional mediation analysis was conducted to estimate the statistical indirect association through depressive symptoms. Finally, sensitivity analyses were conducted to assess the consistency of the observed associations across alternative estimators and outcome definitions. Results Among 864 participants, the median age was 69.00 (64.00–74.00) years; 474 (54.86%) were men, and 214 (24.77%) reported any informal helping. Although several baseline covariates were imbalanced before PS adjustment, adequate balance was achieved afterward. The estimated mean differences from PS matching, stratification, and IPTW were 2.214 (95% CI, 0.987–3.440), 3.519 (95% CI, 2.614–4.424), and 3.588 (95% CI, 2.742–4.433), respectively. The direction of the association was consistent across alternative analytical approaches. An exploratory cross-sectional mediation analysis identified a statistical indirect effect through depressive symptoms (estimate = 2.122, 95% CI, 1.638–2.691; p < 0.001). Conclusion Any informal helping was associated with higher cognitive function scores among older adults. An exploratory analysis also identified a cross-sectional statistical indirect association involving depressive symptoms. These observational findings require further investigation in longitudinal studies.