{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T06:15:11Z","timestamp":1783318511910,"version":"3.54.6"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>China has entered a stage of deep aging. The cognitive function level of the old adults is not only an important indicator to measure their health status and quality of life, but also a key factor reflecting their social adaptability and overall physical and mental state. Against this backdrop, incontinence, as a common health issue among the old adults, not only affects their daily lives but may also further impair cognitive functions through multiple psychological and social mechanisms. Therefore, in order to gain a more comprehensive understanding of the potential pathways of interaction between incontinence and cognitive function in the old adults, this study aims to explore the multiple mediating effects of social participation and depressive symptoms in the relationship between the two, providing theoretical basis and practical reference for promoting cognitive health and enhancing the overall well-being of the old adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>According to the 2018 China Longitudinal Health and Longevity Survey (CLHLS) dataset, a total of 9,299 Chinese old adults aged 65 and above were selected. Firstly, the basic socio-demographic characteristics of the sample population were described. Secondly, a Spearman correlation analysis was conducted to examine the associations among incontinence, social participation, depressive symptoms and cognitive function in the old adults. Finally, sequential multiple mediating analysis was conducted using SPSS Macro PROCESS 4.0 to evaluate the potential mediating role of social participation and depressive symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Incontinence, social participation, depressive symptoms and cognitive function were significantly correlated (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01). Incontinence is not only directly related to the cognitive function of the old adults (effect\u202f=\u202f\u22124.1964; but also has a standard error of 0.2219. 95% confidence interval: LL\u202f=\u202f\u22124.6314, UL\u202f=\u202f\u22123.7615), and the independent mediating effect of social participation (effect\u202f=\u202f\u22120.2256; standard error\u202f=\u202f0.0271; 95% confidence interval: LL\u202f=\u202f\u22120.2795, UL\u202f=\u202f\u22120.1722), independent mediating effect of depressive symptoms (effect\u202f=\u202f\u22120.0856; standard error\u202f=\u202f0.0285; 95% confidence interval: LL\u202f=\u202f\u22120.1438, UL\u202f=\u202f\u22120.0328), the chain mediating effect between social participation and depressive symptoms (effect\u202f=\u202f\u22120.0096; standard error\u202f=\u202f0.0022;95% confidence interval: LL\u202f=\u202f\u22120.0142, UL\u202f=\u202f-0.0057) was associated with major cognitive function.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study suggested that social participation and depressive symptoms may be involved in the association between incontinence and cognitive function among older adults in China. These findings highlight the importance of paying attention to social participation and depressive symptoms in older adults with incontinence, which may help inform strategies for cognitive health promotion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1858662","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T05:37:20Z","timestamp":1783316240000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Incontinence and cognitive function in Chinese old adults: multiple mediating effects of social participation and depressive symptoms"],"prefix":"10.3389","volume":"14","author":[{"given":"Xinlin","family":"Li","sequence":"first","affiliation":[{"name":"Department of Geriatrics, The First Affiliated Hospital of Hunan University of Chinese Medicine","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingyao","family":"Nie","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, The First Affiliated Hospital of Hunan University of Chinese Medicine","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Lin","sequence":"additional","affiliation":[{"name":"Xiangya School of Nursing, Central South University","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anling","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, The First Affiliated Hospital of Hunan University of Chinese Medicine","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, The First Affiliated Hospital of Hunan University of Chinese Medicine","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Penghui","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, The First Affiliated Hospital of Hunan University of Chinese Medicine","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1362","DOI":"10.1016\/S0140-6736(20)32136-X","article-title":"Long-term care system for older adults in China: policy landscape, challenges, and future prospects","volume":"396","author":"Feng","year":"2020","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"8492","DOI":"10.3390\/ijerph17228492","article-title":"Older adult segmentation according to residentially-based lifestyles and analysis of their needs for smart home 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A theory of socioemotional selectivity","volume":"54","author":"Carstensen","year":"1999","journal-title":"Am Psychol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1186\/s12889-023-15324-4","article-title":"Association between calf circumference and incontinence in Chinese elderly","volume":"23","author":"Li","year":"2023","journal-title":"BMC Public Health"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1097\/hjh.0000000000003609","article-title":"Association of depression trajectories and subsequent hypertension and cardiovascular disease: findings from the CHARLS cohort","volume":"42","author":"Qiu","year":"2024","journal-title":"J Hypertens"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1080\/03637750903310360","article-title":"Beyond baron and Kenny: statistical mediation analysis in the new millennium","volume":"76","author":"Hayes","year":"2009","journal-title":"Commun Monogr"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1037\/0021-9010.88.5.879","article-title":"Common method biases in behavioral research: a critical review of the literature and recommended remedies","volume":"88","author":"Podsakoff","year":"2003","journal-title":"J Appl Psychol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"333","DOI":"10.5935\/1984-0063.20210003","article-title":"Sleep quality and urinary incontinence in elderly female exercise practitioners","volume":"15","author":"Da-Luz","year":"2022","journal-title":"Sleep Sci"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/j.jad.2022.02.039","article-title":"Association between the self-reported duration and quality of sleep and cognitive function among middle-aged and older adults in China","volume":"304","author":"Li","year":"2022","journal-title":"J Affect 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Gynecol"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1167","DOI":"10.1080\/13607863.2015.1065792","article-title":"Psychological resilience and active social participation among older adults with incontinence: a qualitative study","volume":"20","author":"Takahashi","year":"2016","journal-title":"Aging Ment Health"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1038\/s43587-023-00387-0","article-title":"Social participation and risk of developing dementia","volume":"3","author":"Sommerlad","year":"2023","journal-title":"Nat Aging"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1111\/j.1532-5415.2000.tb04699.x","article-title":"The association of depressive symptoms and urinary incontinence among older adults","volume":"48","author":"Dugan","year":"2000","journal-title":"J Am Geriatr Soc"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1016\/j.jad.2022.06.075","article-title":"Mediating role of functional limitations in the association of urinary incontinence with depressive symptoms among middle-aged and older adults: the English longitudinal study of aging","volume":"313","author":"Yang","year":"2022","journal-title":"J Affect Disord"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1016\/j.jad.2024.05.165","article-title":"Association between depressive symptoms and cognitive function in the older population, and the mediating role of neurofilament light chain: evidence from NHANES 2013-2014","volume":"360","author":"Xu","year":"2013","journal-title":"J Affect Disord"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1176\/ajp.147.2.187","article-title":"Subcortical hyperintensity on magnetic resonance imaging: a comparison of normal and depressed elderly subjects","volume":"147","author":"Coffey","year":"1990","journal-title":"Am J Psychiatry"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1001\/archpsyc.57.11.1071","article-title":"Cerebral white matter lesions and depressive symptoms in elderly adults","volume":"57","author":"de Groot","year":"2000","journal-title":"Arch Gen Psychiatry"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1176\/ajp.154.4.562","article-title":"Clinically defined vascular depression","volume":"154","author":"Alexopoulos","year":"1997","journal-title":"Am J Psychiatry"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1001\/archpsyc.56.5.425","article-title":"Depressive symptoms and cognitive decline in nondemented elderly women: a prospective study","volume":"56","author":"Yaffe","year":"1999","journal-title":"Arch Gen Psychiatry"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"e44514","DOI":"10.2196\/44514","article-title":"Multidimensional internet use, social participation, and depression 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1982-2015","volume":"57","author":"Li","year":"1982","journal-title":"Demography"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1186\/s12912-026-04508-z","article-title":"Urinary incontinence and its impact on caregiver burden in the oldest-old: a cross-sectional study","volume":"25","author":"Beler","year":"2026","journal-title":"BMC Nurs"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"5535","DOI":"10.3390\/jcm12175535","article-title":"When bladder and brain collide: is there a gender difference in the relationship between urinary incontinence, chronic depression, and anxiety?","volume":"12","author":"Dasdelen","year":"2023","journal-title":"J Clin Med"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"758105","DOI":"10.3389\/fpsyt.2021.758105","article-title":"Impact of different type and frequency of social participation on depressive symptoms among older Chinese adults: is there a gender 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