Beyond health care: Volunteer work, social participation, and late-life general cognitive status in Taiwan

In addition to the complexity associated with health care coverage and its utilization by older people, I hypothesize that social engagement promotes a better later-life general cognitive status beyond health care availability as is provided by Taiwan's National Health Insurance (NHI) system. The present study thus explores whether social engagement, specifically social participation and volunteer work, is independently associated with later-life general cognitive status after adjusting for health service utilization among older Taiwanese via the NHI system.Using a population-based natural experiment study design, data from the Taiwan Longitudinal Study on Aging (TLSA, 1993-2007) was analyzed. Mixed-effects models were conducted to estimate the relative effects of volunteer work, social participation, and NHI on general cognitive status over time, while taking health status, medical care utilization, community development, and social support into consideration.The multivariate findings showed that a better general cognitive status is significantly associated with being actively involved in volunteer work (β = 0.14, p < 0.01) and social participation (β = 0.14, p < 0.01). In addition, NHI is also significantly associated with a higher level of general cognitive status (β = 0.10, p < 0.01).This investigation suggests that social engagement has significant impacts on late-life general cognitive status, even taking into account the NHI system and its related utilization effects. The results highlight the importance of volunteer work and social participation among older Taiwanese because such social involvement produces a positive effect on their general cognitive status beyond health care itself. Furthermore, the contribution of productive activities to enhance late-life cognitive health is underscored.