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Community engagement and dementia risk: time-to-event analyses from a national cohort study
  1. Daisy Fancourt,
  2. Andrew Steptoe,
  3. Dorina Cadar
  1. Department of Behavioural Science and Health, University College London Research Department of Epidemiology and Public Health, London, UK
  1. Correspondence to Dr Daisy Fancourt, Department of Behavioural Science and Health, University College London Research Department of Epidemiology and Public Health, London WC1E 6BT, UK; d.fancourt{at}


Background There is increasing interest in the potential health benefits of referring older adults to engage in community leisure activities (‘social prescribing’) to help promote healthy cognitive ageing. However, it remains unclear whether beneficial effects of community engagement are independent of the well-known protective effects of broader structural, functional and subjective social factors.

Methods We analysed data from 9550 adults aged 50+ from the English Longitudinal Study of Ageing, with baseline from 2004 to 2005. We assessed associations between different types of community engagement and dementia incidence over a 12-year period. Specifically, we used Cox proportional hazards models, competing risk regressions models, and modified Fine and Gray subdistribution hazards models while controlling for all identified demographic, health-related, and social covariates.

Results Community cultural engagement (eg, visiting museums, galleries, the theatre) was associated with a lower hazard of developing dementia in older age independent of demographic, health-related and a broad range of social factors, using all three statistical approaches (fully adjusted Cox models: HR 0.58, 95% CI 0.41 to 0.80). Community group engagement (eg, attending clubs or societies) was only associated with dementia prior to adjustment for social factors. Results were robust to sensitivity analyses considering reverse causality, over-adjustment and baseline cognitive function.

Conclusion It is not just social factors that are associated with reduced risk of dementia onset, but community engagement may also be protective, particularly when relating to cultural activities. These findings are of relevance when considering the current interest in social prescribing to support healthy ageing.

  • dementia
  • ageing
  • social activities
  • psychosocial factors
  • cognition

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  • Contributors All three authors designed the study, DF and DC ran the analyses and drafted the manuscript. All authors critically appraised the manuscript and approved it for submission.

  • Funding The English Longitudinal Study of Ageing was developed by a team of researchers based at the University College London, NatCen Social Research, the Institute for Fiscal Studies, and the University of Manchester. The data were collected by NatCen Social Research and are available from the UK Data Service. The funding is provided by the National Institute of Aging Grant R01AG017644 and a consortium of UK government departments coordinated by the Economic and Social Research Council. DF is supported by the Wellcome Trust [205407/Z/16/Z].

  • Competing interests None declared.

  • Patient consent for publication All participants gave informed consent.

  • Ethics approval Ethical approval was provided by the National Research Ethics Service.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository.