The Influence of Healthy Lifestyle Behaviors on Cognitive Functioning of Older Turkish Women

Background: The world is undergoing an unprecedented rise in the older population due to remarkable increases in life expectancy and declining fertility rate. This rapid growth in the proportion of older adults has been accompanied by the rise in late-life cognitive disorders such as dementia. Recent research has shown a general decline in the incidence of dementia in the United States and other high income Western countries (Langa et al., 2017). However, 68 percent of the estimated increase in the global prevalence of dementia will be in low-and-middle income countries by 2050 (Prince et al., 2016). Prevalence of cognitive impairment and associated lifestyle factors have been focal points for researchers in Turkey where the literature in cognitive aging is limited. Older women in Turkey have been particularly susceptible to cognitive decline due to fewer opportunities in life such as educational or professional attainment (Panpalli Ates, Karaman, Guntekin, & Ergun, 2016). It is crucial to examine the impact of healthy lifestyle behaviors on the cognitive functioning of this group to develop effective strategies to promote their cognitive health.

Purpose: The purpose is to investigate the prevalence of cognitive impairment, and the impact of healthy lifestyle behaviors in older women live in the central Anatolian city of Sivas, Turkey.

Methods: The initial sample of this cross-sectional, correlational study included 116 community-dwelling older women aged between 65 and 91. The sample size was determined based on a priori effect size calculation of (.30) with a power size (.80) and an alpha level (.05). The study was approved by the Sivas Cumhuriyet University Ethical Review Committee (ID: 2016-11/23). We recruited participants in two family health centers in Sivas, using convenience sampling method and collected data between June and September 2017. Each participant consented prior to face to face interviews to collect data. We measured the global cognitive function and healthy lifestyle behaviors, using the Standardized Mini-Mental State Examination (MMSE) and Health-Promoting Lifestyle Profile (HPLP-II), respectively. After dropouts and eliminating the interviews with missing values, 100 participants were included in the final analysis. Descriptive statistics were used to analyze the demographic data and the prevalence of cognitive impairment. In the main analysis, we used the Pearson correlation to determine the relationship between healthy lifestyle behaviors and cognitive functioning and the multiple linear regression to analyze the influence of these behaviors on the outcome.

Results: Descriptive results of the demographic data were: the mean age of 69.58 ±,4.98, no formal education (61%), no professional history (93%) and widowed/no partner (38%). The mean MMSE score was 23.85 ± 3.71. Our frequency analysis revealed that 34 percent of the participants scored below the cut point of 23 in MMSE, indicating a cognitive impairment in various degrees from mild to severe. The prevalence of cognitive impairment in the current study (34%) was similar to the upper bound prevalence of national (31.5%) and international (42%) studies (Arguvanli et al., 2015; Eshkoor, Hamid, Mun, & Ng, 2015). This result along with the demographic data has confirmed previous evidence of the deleterious effect of low-level education on cognitive functioning (Colangeli et al., 2016). Results of the Pearson correlation indicated a positive association between cognitive function and physical activity (r=.249, p<.05), nutrition (r=.262, p<.01), spiritual growth (r= .391, p< .01), interpersonal relationship (r =.367, p<.01) and stress management (r= .373, p< .01), but no association between cognitive function and health responsibility. The social and spiritual factors were positively associated with the cognitive outcome even more than the other aspects. This could be due to the cultural norms of Turkish women to endeavor connectedness with others (Arslantas, Unsal, & Ozbabalik, 2014). Regression results have shown that the total scores of the lifestyle profile accounted for 18.3 % of the variance in cognitive scores [F (6,93) =3.47, p=.004 R²=.183]. Although none of the dimensions was a single significant predictor of the outcome, these findings have indicated that a combination of multiple lifestyle factors may have created a synergistic effect, which in turns, has led to better cognitive functioning.

Conclusion: Our study findings highlight the importance of early detection of cognitive impairment and the urgent need to address healthy lifestyle behaviors in primary care services and multi-faceted public health interventions. The aspects such as nourishing spiritual growth and coping mechanisms as well as providing opportunities for intellectual, social and physical engagement are necessary to promote older women's cognitive health and should be addressed in healthcare policies. The success of elaborating healthy behaviors into daily life is closely related with the identification of what matters the most for these adults and their families. Nurses are well positioned to use their holistic perspective and patterns of knowing for transforming these healthy lifestyle behaviors to meaningful daily life activities per individual`s unique needs.