Attendance of religious services has been shown to be related to several important health outcomes; however, little research to date has examined whether attendance of religious functions and services is related to CD. We found that more frequent religious attendance at Time 1 was related to less CD over a 3-year period even after controlling for demographic, health status, physical functioning, and socioeconomic variables, as well as social support. Although there was neither a significant two-way interaction between gender and religious attendance nor between depressive symptoms and religious attendance, there was a significant three-way interaction between gender, depressive symptoms, and religious attendance. Specifically, the negative impact of infrequent religious attendance on CD was most pronounced among older women with higher levels of depressive symptomatology.
Our study addresses several of the gaps in the current literature outlined by Hill (2008). First, we tested whether the association between religious attendance and CD extended to a biracial sample of community-dwelling older adults from the southeastern United States. Furthermore, we examined the potential indirect effects of religious involvement on CD by testing for interactions with gender and depressive symptoms. We also controlled for baseline mental and physical health to help disentangle the influence of these related variables on CD. In particular, the results obtained here provide evidence against the self-selection hypothesis or that cognitively intact individuals are more likely to attend religious services to begin with because we controlled for baseline cognitive functioning.
Religious attendance and involvement may offer cognitive stimulation that can reduce CD among older adults. Indeed, evidence for the cognitive reserve hypothesis (38
) comes from literature that suggests engaging in social and intellectual leisure activities is related to better ability to cope with pathological changes in the brain (39
). Engaging in such activities may lead to more efficient cognitive networks that delay the manifestation of cognitive difficulties.
Unlike Reyes-Ortiz and colleagues (2008), we did not find a two-way interaction between depressive symptoms and religious attendance such that more frequent attendance, compared with less frequent attendance, was related to less CD across individuals with varying levels of depressive symptoms. However, we did find that this relationship depended on gender, with the interaction between depressive symptoms and religious attendance present among females only. Perhaps, public religious activities hold different functions for women than for men or women differ from men in their level of involvement when attending religious services. For many women, church services may offer unique networking opportunities, structure and organization, and sense of purpose (19
). In fact, there is a strong positive relationship between religious attendance and social contacts (visiting friends, entertaining guests) for women but not for men (40
). Furthermore, given that women are more religious than men throughout the life span (41
), they may experience greater cognitive benefit from their cumulative lifetime exposure to religious services. These particular functions of religious attendance may take on more meaning when women are depressed than when they are not depressed. For women, religious attendance may be a unique form of behavioral activation and engagement, which may be useful for reducing levels of distress and improving health. Little stimulation through low religious attendance, coupled with higher levels of depressive symptoms, may put some women at greater risk for CD. In addition, some have found that women are more likely than men to use religion as a form of consolation or coping when faced with health problems (42
Several limitations of this study should be considered. Although religiosity is a multidimensional construct, religious attendance was assessed in our study using a single item. Indeed, Hill (17
) states that this is a weakness of the current literature. Furthermore, cognitive functioning was assessed using a relatively brief screening measure. Although some have found the SPMSQ to be a sensitive and specific test for dementia (43
), others have reported varying levels of sensitivity and specificity (44
). Another limitation of the current study is that we cannot rule out potential third variables that may have been operating and were unaccounted for in the present analyses. People who attend religious services may have better lifestyle habits, such as refraining from drinking or smoking, which may be responsible for this relationship. Furthermore, religious attendance may reflect general level of mental activity (e.g., someone actively involved in a faith community may not only read scripture but may also be more likely to read in general). Lastly, it is possible that people who were experiencing cognitive problems may have disengaged from religious activities at Time 1, thus explaining the observed relationship.
Another important issue to acknowledge is the high rate of attrition between Time 1 and Time 2. People who died between these time points were more likely to be older and male as well as have less education, income, and social support. They were more likely to be illiterate and have physical health problems, higher levels of depressive symptoms, less social support, poorer cognitive functioning, and lower levels of religious attendance. Therefore, selective mortality may have attenuated the results, but the influence is difficult to gauge due to missing data. Thus, the results obtained may not be generalizable to the population as a whole.
Lastly, we examined participants’ current depressive symptoms as a continuous measure, not whether or not participants met criteria for clinical depression. Therefore, we recommend exercising caution in interpreting our results as applying to women who are clinically depressed. Rather, our results indicate that infrequent religious attendance may affect women with higher than average levels of depressive symptoms.
Given the rate of growth of the aging population in the United States and hence the number of individuals with cognitive impairments, it is critical to identify risk factors for CD to help target vulnerable groups. Our findings suggest that religious attendance may serve as a buffer against CD. However, women with higher levels of depressive symptoms who do not attend religious functions may be at greater risk of CD than those who do indeed attend religious services. Given that religious attendance has been shown to be a unique form of social engagement in this and other studies, clinicians may consider assessing religious involvement when asking about their clients’ levels of engagement in social activities. Additionally, it is common for clinicians to encourage depressed clients to resume activities they have disengaged in as part of the treatment for depression (i.e., behavioral activation). For female clients who may have previously enjoyed regularly attending church activities, this research may serve as a form of rationale provision (i.e., that reengagement may not only help with depressive symptoms but also with cognitive functioning in the future) to build client motivation.