Can Two-Way Intergenerational Support Better Protect Cognitive Function in Chinese Older Adults? A Nationally Representative Study 

Can Two-Way Intergenerational Support Better Protect Cognitive Function in Chinese Older Adults? 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A Nationally Representative Study Sunxi Mao, Tianyu Wang, Xinyi Wang, Zinan Zhang, Zhonghua Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6667791/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 6 You are reading this latest preprint version Abstract Background: Intergenerational support plays a vital role in maintaining cognitive health among older adults. However, whether two-way intergenerational support offers greater protection of cognitive function compared with one-way support—either provided or received—remains poorly understood. Methods: Data were obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS, 2011-2018). An Ordered Probit (Oprobit) model was used to estimate the effect of intergenerational support on cognitive function. Robustness was assessed using the Instrumental Variables with Conditional Mixed Process (IV-CMP) method, and heterogeneity was examined by stratifying the data by residence and gender. Results: Two-way financial, caregiving, and emotional support significantly reduced the risk of cognitive impairment in older adults, particularly in severe cases. Two-way financial support was more effective than either support provided or received alone in reducing the risk of cognitive impairment, whereas two-way caregiving was less effective than providing caregiving support alone. Among the three types of two-way intergenerational support, two-way caregiving demonstrated the strongest protective effect against cognitive impairment in older adults, whereas two-way financial support exhibited the weakest. Finally, notable rural–urban and gender disparities were observed to influence intergenerational support on the risk of cognitive impairment, underscoring the need for targeted interventions to address cognitive decline across diverse demographic groups. Conclusions: The study highlights the protective effects of two-way intergenerational support on cognitive function among older Chinese adults and reveals variations across support types and demographic groups. The findings offer invaluable insights for promoting cognitive health in older adults. One-way intergenerational support Two-way intergenerational support Cognitive impairment Ordered Probit Conditional Mixed Process Figures Figure 1 Figure 2 Background Rapid economic development is expected to gradually shift the global age structure from a pyramid to an olive shape [ 1 ]. Due to the acceleration of population aging in Japan, South Korea, and European countries, these regions will have evolved into some of the world's most super-aged areas by 2025. Data from China's Seventh Population Census (2020) [ 2 ] suggest that the proportion of the population aged ≥65 increased by 4.63% between 2010 and 2020. This rise is 2.72% higher than the previous decade, it is anticipated that the degree of population ageing in China will continue to escalate in the future, surpassing the average level observed in developed countries [ 3 ]. The aging process is marked by a deterioration in functional capabilities and a weakening of social support networks for older adults [ 4 ]. Cognitive impairment is frequently highlighted as one of the most severe functional impairments experienced by older adults. It refers to a condition that significantly impacts essential functions such as learning, language acquisition, and memory retention. China has emerged as the country with the highest number of patients experiencing cognitive impairment worldwide. Approximately one in seven older people experience cognitive impairment, which significantly impacts the quality of life and the level of social engagement [ 5 ]. Therefore, with the growing aging population in China, the prevention and management of cognitive impairment in older adults has become a critical public health priority. In response, the "Healthy China 2030" initiative designates enhancing cognitive health and preventing or delaying the onset of cognitive impairments in older adults as key objectives. In this context, identifying protective factors against cognitive impairment in older adults and exploring the underlying mechanisms will aid in the prevention of cognitive decline, thereby contributing to healthy aging. A large corpus of literature posits that social networks and social support are important for health in old age [ 6 , 7 ], and support from family and society exert a profound influence on cognitive function [ 8 , 9 ]. As individuals age, their social support network tends to shrink, with external sources of support, such as relationships with coworkers and friends, gradually weakening. Consequently, the role of intergenerational support within the family becomes increasingly prominent [ 10 ]. According to the traditional "nurture-support" feedback model [ 11 ], intergenerational support involves a reciprocal exchange, with support flowing both from the child to the parent and vice versa [ 12 ]. Intergenerational support takes two forms: one-way support, provided solely by either the offspring or the parent, and two-way support, involving reciprocal exchanges [ 13 ]. Furthermore, three main types of intergenerational support have been identified: financial, caregiving, and emotional support [ 14 , 15 ]. Although existing research has explored the relationship between intergenerational support and cognitive function in older adults, significant limitations remain in this area. First, most of the existing studies have focused on the effects of a single specific type of intergenerational support on cognitive function. For example, older adults with financial support from their adult children are less likely to develop cognitive impairment [ 16 – 18 ]. According to Sims et al. [ 9 ], receiving financial support from children without the ability to make financial rewards may be negatively associated with cognitive performance in older people. Liao et al. [ 14 ] revealed that moderate intensity and frequency of caregiving was associated with better cognitive function in a Chinese middle-aged and older population. Bon Sanga and Bordoneb [ 19 ] argued that informal care provided by children has a significant negative impact on mothers' cognitive function. Furthermore, Eisele et al. [ 20 ] discovered that emotional support had no effect on cognition; the findings of Xu and Luo [ 21 ] confirmed that emotional support greatly contributed to the cognitive health of middle-aged and older parents. Despite existing literature exploring the relationship between various forms of intergenerational support and cognitive function, the field lacks a comprehensive analysis and comparative study of these different forms of support. Second, most existing research has focused on one-way intergenerational support. Indeed, older adults with higher levels of family support from their children have better cognitive function and slower cognitive decline [ 22 – 24 ]. Peng et al. [ 25 ] revealed that receiving financial or caregiving support from children promoted cognitive performance in rural China. However, the provision of primary financial support by the offspring may also increase the risk of cognitive impairment in older adults [ 26 ]. Zwar et al. and Sharma et al. [ 27 , 28 ] collectively discovered that both sharing household chores and providing informal caregiving support to children can have a protective effect on the cognitive function of older adults, with a particular benefit observed female caregivers. Older parents who provide support to their children are more likely to have cognitive impairment because informal caregivers are under more stress than non-caregivers [ 29 – 31 ]. Although previous research has investigated the effect of intergenerational support on cognitive function in older adults, limited attention has been given to the reciprocal nature of intergenerational support. Two-way intergenerational support, characterized by the reciprocal exchange of resources and emotions, may exert a more pronounced influence on cognitive health in older adults by fostering intergenerational balance. Therefore, the association between two-way intergenerational support and cognitive function in older adults warrant further investigation. In summary, although some studies have explored the relationship between intergenerational support and cognitive function in older adults, they have not offered a comparative analysis of different types of intergenerational support. More importantly, there is a notable gap in the literature regarding the effect of two-way intergenerational support, as compared to one-way support, on cognitive function in older adults. In this study, based on a nationally representative survey from China, we first used the Ordered Probit (Oprobit) model and marginal effects to examine the effects of different types of two-way and one-way intergenerational support on cognitive function in older adults. Subsequently, we applied the Instrumental Variable with Conditional Mixed Process (IV-CMP) estimation method to test the robustness between intergenerational support and cognitive function. Finally, to account for potential differences between urban and rural areas in China, as well as gender disparities, we stratified the extracted data by geographic region and gender to analyze heterogeneity. Methods Data source The data utilized in this study derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) [ 32 ], which was conducted by Peking University and the Chinese Center for Disease Control and Prevention, spanning the years 2011, 2014, and 2018. In the survey, a random selection of half the total number of counties and cities from 22 Chinese provinces served as survey sites, thereby covering approximately 85% of the country's population. Unequally proportional random sampling and multistage sampling methods were used to survey adults aged ≥ 65 years. The original dataset consisted of 32,831 observations. After excluding cases with missing data, the final sample included 21,528 individuals: 7771 individuals in 2011, 4667 in 2014, and 9090 in 2018.The CLHLS dataset provides comprehensive data on demographics, family structure, economic status, lifestyle, intergenerational support, health, and cognitive function. Statistical analysis was performed using STATA software (v.14.0; STATA Corp., College Station, TX, USA). Data analysis Ordered Probit model The dependent variable in this study is the cognitive function of older adults, which is measured on a discrete ordinal scale ranging from 0 to 3. 0, 1, 2, and 3 representing “No cognitive impairment,” “Mild cognitive impairment,” “Moderate cognitive impairment,” “Severe cognitive impairment,” respectively. Given the ordinal nature of the data, the Ordered Probit (Oprobit) model was deemed more appropriate for analysis, formulated as follows: $$\:{mmse}^{*}=F(\alpha\:+\beta\:{support}_{i}+\gamma\:{control}_{i}+{\epsilon\:}_{i})$$ Where \(\:{mmse}^{*}\) represents the latent variable of cognitive function of the \(\:i\) th older adult; \(\:{support}_{i}\) represents the intergenerational support, \(\:{control}_{i}\) represents a series of control variables including socio-demographic characteristics, lifestyle habits, health status and social security; and \(\:{\epsilon\:}_{i}\) is the random error term. The function F(.) represents a nonlinear mapping. The coefficients of the Oprobit model denote the direction of change in the underlying latent variable rather than directly influencing the probability of the outcome. Consequently, these coefficients are not immediately interpretable, necessitating the computation of marginal effects to elucidate the impact of independent variables on the dependent variable. Marginal effects quantify the average shift in the dependent variable in response to a minute change in the independent variable, formulated as follows: \(\:ME\left({support}_{i}\right)=\) Φ \(\:\left({\beta\:}_{0}+{\beta\:}_{1}{support}_{i}+{\beta\:}_{2}{control}_{i}+{\sigma\:}_{j}\right)·\varphi\:\left({\beta\:}_{0}+{\beta\:}_{1}{support}_{i}+{\beta\:}_{2}{control}_{i}+{\sigma\:}_{j-1}\right)·{\beta\:}_{j-1}\) \(\:ME\left({support}_{i}\right)\) represents the marginal effect of the independent variable \(\:{support}_{i}\) and denotes the probability of change in the dependent variable \(\:{mmse}_{j}\) across categories when \(\:{support}_{i}\) is increased by one unit. Φ is the cumulative distribution function of the standard normal distribution. \(\:\varphi\:\) is the probability density function of the standard normal distribution and \(\:{\sigma\:}_{j}\) is the delimitation threshold parameter, which is used to identify different categories of the dependent variable. Robust test model To address endogeneity issues, including self-selection bias and collider bias in the Oprobit model, this study employed an Instrumental Variable with Conditional Mixed Process (IV-CMP) estimation method, as developed by Roodman [ 33 ], to ensure robust analysis. This approach optimizes the treatment effect of intergenerational support, verifies the causal relationship between intergenerational support and cognitive function, and provides more robust conclusions. IV-CMP requires prioritizing the identification of appropriate instrumental variables. To ensure their validity, we conducted a weak instrumental variable test for linear models to scrutinize the regression outcomes [ 34 ]. Variable selection Cognitive function The Mini-Mental State Examination (MMSE) was employed to evaluate the cognitive function of the respondents. The MMSE consists of five dimensions: orientation, memory, attention and calculation, recall, and language ability, with a total of 30 items. The overall score ranges from 0–30. Higher scores indicate better cognitive function. The level of cognitive function of older adults was categorized into four categories of cognitive based on MMSE international standards [ 35 ]: no impairment (24–30 points), mild impairment (18–23 points), moderate impairment (10–17 points), and severe impairment (0–9 points). Intergenerational support A total of three independent variables were established from the three types of intergenerational support: (i) Intergenerational financial support : The intergenerational financial support variable derived from the questionnaire items: "In the past year, how much money in cash (or in kind) did your children give you?" and "In the past year, how much money in cash (or in kind) did you give your children?" The responses to these questions were used to categorize the receipt and provision of financial support respectively. In our study, intergenerational financial support was categorized into four distinct classifications: “No support” if neither providing nor receiving exceeded $ 0 per year; “Provided financial support alone” if the older adult provided more than $ 0 per year but did not receive any support; “Received financial support alone” if the older adult received over $ 0 per year but did not provide any support; and “Two-way financial support” if the older adult both provided and received support exceeding $ 0 per year. (ii) Intergenerational caregiving support : The intergenerational caregiving support variable derived from the questionnaire items: "Who primarily cares for you when you are not feeling well or when you are sick?" and "Are you currently engaged/participated in any of the following activities? Such as housework (cooking, childcare, etc.)". The responses to these questions were used to categorize the receipt and provision of caregiving support respectively. The receipt of caregiving support was categorized as "Yes" if the answer to the first question was children, grandchildren, or similar relatives, and "No" for all other responses. The provision of caregiving support was defined as "Yes" if the second question was answered affirmatively, and "No" in all other cases. Intergenerational caregiving support was classified into four categories: “No support,” defined as the absence of both providing and receiving care; “Provided caregiving support alone,” when the older adult provided childcare exclusively to their children; “Received caregiving support alone,” when the older adult received informal care exclusively from their children; and “Two-way caregiving support,” when the older adult both provided and received caregiving support. (iii) Intergenerational emotional support : Intergenerational emotional support is inherently reciprocal and bidirectional [ 36 ]. It was defined using the questionnaire item, "Who do you talk to the most in your spare time?" Responses were coded as "Intergenerational emotional support exists" if participants selected "son, daughter, daughter-in-law, son-in-law, grandchildren, or spouse," and as "No intergenerational emotional support exists" for all other responses. Therefore, 0 signified the absence of intergenerational emotional support, whereas 1 indicated the presence of such support. Instrumental variable selection in the IV-CMP model A valid instrumental variable in IV-CMP model must satisfy two fundamental conditions: it must be correlated with the endogenous explanatory variable and uncorrelated with the dependent variable. The instrumental variable selected for this study was the number of children, as identified in a previous study [ 37 ]. Intergenerational support is strongly correlated with the number of children older adults have [ 38 ]. A greater number of children can increase the demands on older parents to provide financial, caregiving, and emotional support. Meanwhile, older adults with more children are likely to receive greater resources and emotional support from their offspring. However, the number of children does not directly affect the cognitive function of older parents. Thus, it serves as a valid instrumental variable in our analysis. To test the validity of the instrumental variable, we used the weak instrumental variable method. Other control variables Other control variables included socio-demographic characteristics, lifestyle habits, health status and social security. Socio-demographic characteristics variables included age, gender, duration of formal education, residential area, marital status, and income. Income level was categorized based on annual household earnings as ≤ 30,000, 30,001–50000, 50,001–100000, and > 100,000 Yuan. Lifestyle habits variables included smoking, drinking, and daily exercise. Health status variables refer to hearing impairment, self-reported health, chronic disease, depression, and activities of daily living (ADL). ADL was assessed using the Katz scale [ 39 ] and categorized into three groups based on scores: no, low, and high disability. Social security variables included participation in insurance and community services. Results Basic characteristics of participants Table 1 provides a detailed description of the samples. Overall, 79.3% of individuals were aged ³75 years and 43.6% of the participants were male. Half of the older adults (51.6%) lived in the urban areas and 86.2% of the participants reported £6 years of formal education. Furthermore, more than half of the participants had no spouse (59.8%), reported no hearing impairment (56.8%), and had an annual income £30,000 Yuan (62.3%). Less than one-third participated in exercise (31.0%), and 83.5% and 84.5% of the participants were non-smokers and non-drinkers, respectively. Approximately 24.6% of the participants reported a disability, and more than half reported diagnosis with at least one chronic disease (62.4%). Furthermore, 12.7% of older adults in this study experienced symptoms of depression. The majority of participants in the sample (81.8%) have social insurance. Intergenerational support and cognitive function among the older adults Table 2 shows the status of intergenerational support and cognitive function. In terms of financial support, ~45.0% of older adults received financial support alone from their children, 4.0% provided financial support alone to their children, and 34.1% of older adults experienced a two-way financial support arrangement with their children. Regarding caregiving support, 20.7% of older adults provided caregiving alone to their children, 35.1% received caregiving alone from their children, and 35.0% of older adults engaged in two-way intergenerational caregiving. With regard to intergenerational emotional support, 75.2% of older participants reported intergenerational emotional support with their children. As shown in Table 3, 34.2% of older adults in the sample experienced cognitive impairment. Specifically, 13.6%, 9.1%, and 11.5% of the older demographic exhibited mild, moderate, and severe cognitive impairment, respectively. Effects of intergenerational support on cognitive function among the older adults Table 3 shows the association between intergenerational support and cognitive function. After controlling for socio-demographic factors, older adults who provided financial support alone (Coef.=-0.164), received financial support alone (Coef.=-0.080), and engaged in two-way financial support with their children (Coef.=-0.197) were all significantly associated with a lower risk of cognitive impairment. Regarding intergenerational caregiving support, whose who had provided caregiving alone was significantly associated with a lower risk of cognitive impairment in older adults (Coef.=-0.374), as was two-way caregiving support (Coef.=-0.267). In contrast, having received caregiving alone was significantly associated with a higher risk of cognitive impairment in older adults (Coef.=0.112). Furthermore, a significant negative correlation between intergenerational emotional support and cognitive impairment was observed in older adults (Coef.=-0.241). Other socio-demographic factors, including age, gender, duration of formal education, residential area, marital status, exercise, hearing impairment, self-reported health, chronic disease, depression, ADL, having insurance, and community services, were significantly associated with cognitive function. Table 4 summarizes the results of the marginal effects analysis, which revealed that intergenerational support had an effect on cognitive function. Older adults who provided financial support alone had less likelihood of mild, moderate, and severe cognitive impairment by 0.9%, 0.9%, and 1.8%, respectively. Similarly, having received financial support alone was associated with reductions in the likelihood of mild, moderate, and severe cognitive impairment by 0.4%, 0.4%, and 0.9%, respectively. In contrast, two-way financial support was more effective in reducing the risk of cognitive impairment, with reductions of 1.1%, 1.1%, and 2.2%, respectively. Regarding caregiving support, two-way caregiving support reduced the likelihood of mild, moderate, and severe cognitive impairment in older adults by 1.7%, 1.7%, and 2.9%, respectively. Having provided caregiving support alone was associated with a 2.4%, 2.3%, and 3.8% reduction in the likelihood of cognitive impairment, respectively. However, having received caregiving support alone had a detrimental effect, increasing the likelihood of mild, moderate, and severe cognitive impairment in older adults by 0.7%, 0.7%, and 1.4%, respectively. Furthermore, intergenerational emotional support reduced the likelihood of mild, moderate, and severe cognitive impairment by 1.2%, 1.3%, and 2.8%, respectively. Robustness test based on the IV-CMP estimation The results of the IV-CMP analysis provided robust evidence of the significant effect of intergenerational support on cognitive function (Table 5). The Atanhrho_12 parameters (0.641, 0.284, 0.567) were all significant at the 1% level, indicating that intergenerational financial, caregiving, and emotional support are endogenous variables, supporting the reliability of the IV-CMP model. The number of children correlated with all three endogenous variables (Financial: 0.065; Caregiving: 0.089; Emotional: 0.024), confirmed the validity of the instrumental variable in addressing endogeneity. The IV-CMP results revealed that intergenerational support—both one-way and two-way—significantly mitigated cognitive impairment. These findings were consistent with the Oprobit model analyses, except for the case of having received caregiving support alone, indicating the robustness of the results. The mitigating effects of intergenerational support on cognitive impairment in the IV-CMP model were as follows: provided financial support alone (-0.451), received financial support alone (-0.794), two-way financial support (-1.617), provided caregiving support alone (-0.605), received caregiving support alone (-0.468), two-way caregiving support (-1.121), and intergenerational emotional support (-1.047). In addition, we conducted the weak instrumental variable test(Table 6), the F-statistics for all columns were >10 and were considered significant at the 1% level (Financial: F=1282.81; Caregiving: F=1326.77; Emotional: F=1991.74); the Wald test also revealed that the smallest eigenvalue statistic exceeded the 10% critical value, providing strong evidence that the number of children is not a weak instrument. Heterogeneity analysis Urban-rural heterogeneity Figure 1 summarizes the urban-rural disparities in the marginal effect of intergenerational support on cognitive function in older adults. All the regression estimates were controlled for socio-demographic factors. The Chow test was used to examine differences in the formation coefficients (Chow test =2.89, P＜0.01). Having provided financial support alone reduced the risk of mild, moderate, and severe cognitive impairment by 0.8%, 0.8%, and 1.6% in urban-living older adults, which was significantly lower than that in their rural counterparts (1.2%, 1.3%, and 2.5%, respectively), whereas having received financial support alone reduced the risk by 0.5%, 0.5%, and 1.1% in urban older adults but had no significant effect in rural populations. Two-way financial support reduced the risk of mild, moderate, and severe cognitive impairment by 1.3%, 1.2%, and 2.5% in urban older adults, which was significantly higher than that of their rural counterparts (0.8%, 0.9%, and 1.8%). Regarding intergenerational caregiving support, having provided caregiving support alone reduced the risk of moderate and severe cognitive impairment by 2.3% and 3.7% in urban older adults, significantly lower than in rural areas (2.5% and 4.1%). However, having received caregiving support alone increased the risk of mild, moderate, and severe cognitive impairment by 0.7%, 0.8%, and 1.4% in urban older adults, with no significant effect in rural counterparts. Two-way caregiving support reduced the risk of mild, moderate, and severe cognitive impairment by 1.5%, 1.4%, and 2.3%, respectively, in urban older adults, which was significantly lower than that in rural areas (2.0%, 2.1%, and 3.6%). In addition, having received intergenerational emotional support significantly reduced the risk of moderate and severe cognitive impairment by 1.2% and 2.6%, respectively, in urban-living older adults, which was significantly lower than the rates observed in rural counterparts (1.4% and 3.0%). Gender-based heterogeneity Figure 2 presents findings supporting gender-based disparities in the marginal effect of intergenerational support on cognitive function among older adults (Chow test=9.26, p<0.01). Having provided financial support alone reduced the risk of mild, moderate, and severe cognitive impairment by 0.7%, 1.0%, and 2.5% in older females, with no significant effect observed in older men; a similar pattern was observed in adults having received financial support alone (0.5%, 0.7%, 1.9%, respectively). Two-way financial support reduced the risk of mild, moderate, and severe cognitive impairment by 0.8%, 0.6%, and 0.9% in older men, which was significantly lower than that observed in older women (0.9%, 1.4%, and 3.4%). Having provided caregiving support alone reduced the risk of moderate and severe cognitive impairment in older men by 1.7% and 2.3%, respectively, which was significantly lower than that observed in older women (2.8% and 5.2%). Having received caregiving support alone reduced the risk of mild, moderate, and severe cognitive impairment in older men by 1.0%, 0.8%, and 1.2%, respectively, whereas, in older women, it had no significant effect on mild or moderate impairment but increased the risk of severe cognitive impairment by 1.5%. Two-way caregiving support reduced the risk of moderate and severe cognitive impairment in older men by 1.2% and 1.6%, respectively, which was lower than the reductions observed in older women (2.1% and 4.1%, respectively). Similarly, intergenerational emotional support reduced the risk of moderate and severe cognitive impairment in older men by 1.0% and 1.7%, respectively, which were significantly lower than the corresponding reductions in women (1.4% and 3.8%). Discussion Intergenerational support plays a crucial role in mitigating cognitive impairment [ 40 ]. However, the effect of two-way intergenerational support on cognitive function in older adults remains insufficiently understood. Our study conducted a comparative analysis of the effects of two-way and one-way intergenerational support on cognitive function among older Chinese adults. Additionally, robustness checks and heterogeneity analyses were performed, stratifying the data by geographic region and gender. The marginal effects analysis revealed that two-way financial support, two-way caregiving support, and intergenerational emotional support all had a significant mitigating effect on varying degrees of cognitive impairment risk, particularly for severe patients. These findings were further validated through robustness tests. Regarding one-way intergenerational support, having provided financial support alone, having received financial support alone, and having provided caregiving support alone were also significantly associated with a reduced risk of varying degrees of cognitive impairment. These findings aligned with existing research [ 16 – 18 ]. Therefore, fostering intergenerational support may be an effective strategy for mitigating cognitive impairment risk in older adults. Furthermore, our study found that two-way financial support was more effective than one-way support in reducing the risk of cognitive impairment of varying degrees. This result supports the view that reciprocal financial exchanges involves not only the transfer of financial resources but also fosters a sense of mutual responsibility and contribution, as well as active communication and engagement between the giver and the receiver [ 40 ]. This reciprocal interaction may play a more effective protective role in preserving cognitive health in older adults. In contrast, although receiving or providing financial support alone may reduce the risk of cognitive impairment in older adults, it offers less interaction and feedback, thereby limiting its protective effects on cognitive function [ 41 ]. Hence, strategies that encourage reciprocal financial exchanges between older adults and their families, such as establishing a shared family financial support system, should be promoted to effectively enhance cognitive well-being for older adults. Unexpectedly, two-way caregiving support had a weaker effect on reducing the risk of cognitive impairment in older adults compared with having provided caregiving support alone in older adults. Two-way caregiving involves frequent role switching and responsibility sharing, requiring older adults to alternate between being caregivers and care recipients. This role conflict may lead to distraction and depletion of cognitive resources [ 42 ], which could diminish the protective effect of intergenerational support on cognitive impairment. In contrast, previous studies have shown that when older adults provided caregiving alone to their children, the roles were clearer and tasks more defined, allowing for better cognitive resource allocation[ 15 ]. Moreover, when older adults provide caregiving alone, it may maximize their self-worth and sense of accomplishment [ 43 ], thereby better supporting cognitive health. Our findings also indicated that emotional support, as a form of two-way intergenerational support, was also significantly associated with a reduced risk of cognitive impairment in older adults, particularly for severe cases, which is in agreement with a previous report [ 40 ]. Therefore, targeted interventions should promote intergenerational emotional support through family engagement, strengthening family cohesion, enhancing emotional bonds, and reducing risk of cognitive impairment. Our findings indicate that, among the three types of two-way intergenerational support, two-way caregiving support exhibited the most significant mitigating effect on the risk of cognitive impairment by varying degrees in older adults, although two-way financial support had the weakest effect. This may be attributed to the fact that, in contrast with financial support, two-way caregiving support requires more direct involvement in the daily lives of older adults. It not only addresses their physical needs but also fosters meaningful interactions between caregivers and recipients. Providing and receiving caregiving requires problem-solving, decision-making, and active communication [ 27 ], which play a crucial role in promoting mental well-being and preserving cognitive function in older adults. Meanwhile, having provided caregiving support alone had the most significant effect on mitigating the risk of cognitive impairment among the three types of one-way intergenerational support. It also demonstrated a stronger effect on reducing cognitive impairment risk compared with the two-way caregiving support, as noted above. Therefore, interventions to prevent cognitive impairment should prioritize encouraging older adults to assume appropriate caregiving responsibilities and promote reciprocal caregiving relationships, as these may enhance cognitive engagement, emotional connection, and social interaction. Rural China is typically characterized by multigenerational family structures and close intergenerational bonds, whereas urban areas increasingly consist of smaller, more variable nuclear family units [ 44 ]. Our findings indicate that rural older adults may derive greater cognitive benefits from providing financial support alone to their offspring compared with their urban counterparts, which is consistent with previous studies [ 25 ]. Meanwhile, having received financial support alone had no significant effect on adult cognition in rural areas. Given the more homogeneous social structures and traditional cultural norms in rural China, such as filial piety, patriarchal family structure, and family collectivism [ 45 , 46 ], older adults living in a rural setting may view providing—rather than receiving—financial support as a key way to affirm their social value and autonomy, which may contribute to a greater sense of self-worth and, in turn, result in enhanced cognitive benefits. However, our study showed that two-way financial support acted a stronger protective factor against cognitive impairment among urban older adults than among their rural counterparts. This may be due to the weaker influence of traditional norms in urban areas [ 44 ], where both providing and receiving financial support benefit cognition health. Additionally, urban environments offer better healthcare access, social participation, and promotion of healthy behavior [ 47 ], enhancing the efficacy of intergenerational financial support in protecting cognitive health. In terms of intergenerational caregiving support, our findings revealed that both two-way caregiving support and providing caregiving alone were more effective in reducing the risk of cognitive impairment among rural older adults than that among their urban counterparts. A possible explanation is that multigenerational family structures, stronger intergenerational ties, and traditional caregiving roles in rural China provide a greater sense of fulfillment and family engagement [ 48 ], which better protects the cognitive health of older adults. Finally, our study indicates that intergenerational emotional support was linked to a reduced risk of moderate and severe cognitive impairment in both urban and rural areas, with a stronger impact on in rural settings. This finding may be attributed to the relatively stable family structures, stronger intergenerational ties, deeper cultural continuity, and reduced environmental stress present in rural communities [ 49 ], which together enhance the buffering effects of emotional support on cognitive impairment. Regarding gender disparities on the effects of intergenerational support on cognitive function among older adults, our study found that two-way financial support was more beneficial for women than men, especially in reducing the risk of moderate and severe cognitive impairment. Meanwhile, both providing and receiving financial support alone have stronger effects on reducing the risk of cognitive impairment in older women than those in older men, which is in accordance with previous studies [ 27 , 28 , 50 ]. In addition, both caregiving support—whether provided alone or two-way—and intergenerational emotional support showed stronger protective effects among older women than men, especially in reducing moderate and severe cognitive impairment risk, which contrasts with the findings of recent research [ 15 ]. These gender-based disparities may stem from the traditional caregiving role of the woman, stronger emotional engagement in family relationships, greater sensitivity to reciprocity, and heightened psychological gains from support exchanges [ 51 , 52 ]. These factors may enhance their sense self-worth and emotional well-being, thereby contributing more significantly to cognitive health. Therefore, it is essential to implement gender-based sensitive strategies that promote flexible caregiving roles, challenge traditional gender-based norms, and ensure access to mental health support, thereby enabling both men and women to fully benefit from intergenerational support and maintain cognitive health in later life. Our study was subject to certain limitations that should be acknowledged. Firstly, the absence of unified criteria for selecting measurement indicators in current research on intergenerational support may constrain the generalizability and comparability of our findings. Additionally, the reliance on self-reported data in the questionnaire design introduces the potential for recall bias, which may compromise the accuracy and validity of the data. Thirdly, the selection of control variables may lack sufficient comprehensiveness, potentially limiting the scope and robustness of the study findings. Conclusion Our study suggested that in China, two-way financial, caregiving, and emotional support significantly reduced the risk of cognitive impairment, especially for more severe patients. Moreover, two-way financial support was more effective than one-way support in reducing the risk of cognitive impairment by varying degrees. However, two-way caregiving support had a weaker effect on reducing cognitive impairment risk in older adults compared with having provided caregiving support alone. Furthermore, our data showed that two-way caregiving had the strongest effect in reducing the risk of cognitive impairment among the three types of two-way intergenerational support, whereas two-way financial support had the weakest. Finally, our findings revealed disparities in the effect of intergenerational support on cognitive function comparing older adults from rural and urban areas and between men and women; this provides a scientific basis for designing tailored intervention strategies to address cognitive impairment risks in different demographic groups. Abbreviations Oprobit Ordered Probit IV-CMP Instrumental Variable with Conditional Mixed Process CLHLS Chinese Longitudinal Healthy Longevity Survey MMSE Mini-Mental State Examination ADL Activities of Daily Living Declarations Ethics approval and consent to participate This study was approved by the Academic Research Ethics Committee of Nanjing Medical University; reference number: 2022460. All procedures were in accordance with the ethical standards of the Helsinki Declaration. Participants provided informed consent prior to data collection. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding This study was funded by National Natural Science Foundation of China (No.72374108). The funding bodies were not involved in the design of the study, or data collection, analysis, and interpretation or in writing the manuscript. Authors' contributions Sunxi Mao: Leading the analysis of the data and writing the draft of the manuscript; Tianyu Wang: Participating in data analysis and writing; Xinyi Wang: Contributing to writing; Zinan Zhang and Zhonghua Wang: Contributing equally to the study design, interpretation of the data and helped in the writing of the final draft of the manuscript. All authors read and approved the final manuscript. Acknowledgments Thanks to all participants for their support and assistance with our research. Data availability The study utilized data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which is publicly available in the CLHLS repository, https://opendata.pku.edu.cn/dataset.xhtml?persistentId=doi:10.18170/DVN/WBO7LK Clinical trial number Not applicable. References Zhang H, Zhang H, Zhang J. Demographic age structure and economic development: evidence from chinese provinces. Journal of Comparative Economics. 2015;43:170–85. Akimov AV, Gemueva KA, Semenova NK. The seventh population census in the PRC: results and prospects of the country’s demographic development. Her Russ Acad Sci. 2021;91:724–35. The Lancet. Population ageing in China: crisis or opportunity? Lancet. 2022;400:1821. Deary IJ, Corley J, Gow AJ, Harris SE, Houlihan LM, Marioni RE, et al. Age-associated cognitive decline. Br Med Bull. 2009;92:135–52. Campos ACBF, Teixeira IG, Moraes N de S, Cadorin I de J, Morelli PM, Lidio AV, et al. Prevalence of cognitive impairment and associated factors in older people. J Affect Disord. 2024;355:283–9. R B, C H, Am A, Ab N, Kj M. Social networks, social support, and life expectancy in older adults: the Cardiovascular Health Study. Arch Gerontol Geriatr. 2023;111:104981. Jeon H, Chung Y, Chung S, Song A. The Influence of Social Networks and Social Support on Health Among Older Koreans at High Risk of Depression. Care Manag J. 2016;17:70–80. Fan Z, Lv X, Tu L, Zhang M, Yu X, Wang H. Reduced social activities and networks, but not social support, are associated with cognitive decline among older chinese adults: a prospective study. Soc Sci Med (1982). 2021;289:114423. Sims RC, Hosey M, Levy S-A, Whitfield KE, Katzel LI, Waldstein SR. Distinct functions of social support and cognitive function among older adults. Exp Aging Res. 2014;40:40–59. Li C, Jiang S, Zhang X. Intergenerational relationship, family social support, and depression among Chinese elderly: A structural equation modeling analysis. J Affect Disord. 2019;248:73–80. Fingerman KL, Sechrist J, Birditt K. Changing views on intergenerational ties. Gerontology. 2013;59:64–70. Chen F, Liu G, Mair CA. Intergenerational Ties in Context: Grandparents Caring for Grandchildren in China. Soc Forces. 2011;90:571–94. Wang P. The influence of intergenerational support on cognitive functioning among middle-aged Chinese: Moderation by personal income. Arch Gerontol Geriatr. 2024. https://doi.org/10.1016/j.archger.2024.105393. Liao S, Qi L, Xiong J, Yan J, Wang R. Intergenerational Ties in Context: Association between Caring for Grandchildren and Cognitive Function in Middle-Aged and Older Chinese. Int J Environ Res Public Health. 2020;18:21. Yang Q, Jia J. Association of intergenerational relationships with cognitive impairment among Chinese adults 80 years of age or older: prospective cohort study. BMC Geriatr. 2022;22:838. Xu P, Burr JA, Kim K, Cong Z. Intergenerational financial exchange and cognitive impairment among older adults in China. Aging Ment Health. 2019;23:1209–17. Deng J, Hu J, Wu W, Dong B, Wu H. Subjective well-being, social support, and age-related functioning among the very old in China. Int J Geriatr Psychiatry. 2010;25:697–703. Wang B, He P, Dong B. Association between family functioning and cognitive impairment among Chinese nonagenarians/centenarians. Geriatr Gerontol Int. 2015;15:1135–42. Bonsang E, Bordone V. The Effect of Informal Care from Children on Cognitive Functioning of Older Parents. SSRN Electron J. 2013. https://doi.org/10.2139/ssrn.2251784. M E, T Z, M K, B W, K H, F T, et al. Influence of social support on cognitive change and mortality in old age: results from the prospective multicentre cohort study AgeCoDe. BMC geriatrics. 2012;12. Xu Y, Luo Y. The Effect of Adult Children’s Education Attainment on Their Parents’ Cognitive Health: An Intergenerational Support Perspective. Front Public Health. 2022;10:744333. Zhu S, Hu J, Efird JT. Role of social support in cognitive function among elders. J Clin Nurs. 2012;21:2118–25. Kelly ME, Duff H, Kelly S, McHugh Power JE, Brennan S, Lawlor BA, et al. The impact of social activities, social networks, social support and social relationships on the cognitive functioning of healthy older adults: a systematic review. Syst Rev. 2017;6:259. Ping W, Bei G. A Longitudinal Study of the Effect of Intergenerational Support on Cognitive Function of Rural Elderly. Popul J. 2011. Peng C, Burr JA, Han SH. Cognitive function and cognitive decline among older rural Chinese adults: the roles of social support, pension benefits, and medical insurance. Aging Ment Health. 2023;27:771–9. Yang Q, Jia J. Association of intergenerational relationships with cognitive impairment among Chinese adults 80 years of age or older: prospective cohort study. BMC Geriatr. 2022;22:838. Zwar L, König H-H, Hajek A. The impact of different types of informal caregiving on cognitive functioning of older caregivers: Evidence from a longitudinal, population-based study in Germany. Soc Sci Med. 2018;214:12–9. Sharma N, Chakrabarti S, Grover S. Gender differences in caregiving among family - caregivers of people with mental illnesses. World J Psychiatry. 2016;6:7. Pinquart M, Sörensen S. Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis. Psychol Aging. 2003;18:250–67. Lupien SJ, McEwen BS, Gunnar MR, Heim C. Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nat Rev Neurosci. 2009;10:434–45. Minkler M. Depression in grandparents raising grandchildren: results of a national longitudinal study. Arch Fam Med. 1997;6:445–52. Center For Healthy Aging And Development Studies. The Chinese Longitudinal Healthy Longevity Survey (CLHLS)-Longitudinal Data（1998-2018）. 2020. Roodman D. Fitting Fully Observed Recursive Mixed-process Models with cmp. The Stata Journal: Promoting communications on statistics and Stata. 2011;11:159–206. Chyi H, Mao S. The Determinants of Happiness of China’s Elderly Population. J Happiness Stud. 2012;13:167–85. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98. Sommer S, Buhl HM. Intergenerational transfers: associations with adult children’s emotional support of their parents. J Adult Dev. 2018;25:286–96. Bolin K, Lindgren B, Lundborg P. Informal and formal care among single-living elderly in Europe. Health Econ. 2008;17:393–409. Zhang J, Li J, Li C, Wang J. The impact of intergenerational support on older adults’ life satisfaction in China: Rural-urban differences. Healthc Rehabil. 2025;1:100011. Katz S. STUDIES OF ILLNESS IN THE AGED. THE INDEX OF ADL: A STANDARDIZED MEASURE OF BIOLOGICAL AND PSYCHOSOCIAL FUNCTION. JAMA. 1963;185:914. Sharifi S, Babaei Khorzoughi K, Khaledi-Paveh B, Rahmati M. Association of intergenerational relationship and supports with cognitive performance in older adults: A systematic review. Geriatr Nur (Lond). 2023;52:146–51. Shu Z, Xiao J, Dai X, Han Y, Liu Y. Effect of family “upward” intergenerational support on the health of rural elderly in China: evidence from chinese longitudinal healthy longevity survey. PLOS One. 2021;16:e0253131. Yoo L, Moon CS, Park I, Lee M, Choi GE. Dual caregiving burden for older parents and grandchildren in middle-aged and older adults: a concept analysis. J Korean Gerontol Nurs. 2023;25:335–45. Adam S, Bonsang E, Grotz C, Perelman S. Occupational activity and cognitive reserve: implications in terms of prevention of cognitive aging and alzheimer’s disease. Clin Interv Aging. 2013;8:377–90. Liu J. Ageing, migration and familial support in rural china. Geoforum. 2014;51:305–12. Yuan X, Wang Q. A tentative study on differences and integration of sino-western filial piety culture. Asian Soc Sci. 2011;7:p97. Yan Y. Intergenerational intimacy and descending familism in rural north China. Am Anthropol. 2016;118:244–57. Sarkar C, Webster C. Urban environments and human health: current trends and future directions. Curr Opin Environ Sustain. 2017;25:33–44. Shi J. The evolvement of family intergenerational relationship in transition: mechanism, logic, and tension. J Chin Sociol. 2017;4:20. Wu X, Yuan Z. Understanding the socio-cultural resilience of rural areas through the intergenerational relationship in transitional china: case studies from guangdong. J Rural Stud. 2023;97:303–13. Okamoto K, Tanaka Y. Gender differences in the relationship between social support and subjective health among elderly persons in Japan. Prev Med. 2004;38:318–22. Glauber R. Gender differences in spousal care across the later life course. Res Aging. 2017;39:934–59. Tavero IL, García EG, Seda JM, Serrano RR, Cabrera IMC, Rodríguez AA. The gender perspective in the opinions and discourse of women about caregiving. Rev Esc Enferm USP. 2018;52:e03370. Tables Table 1 ． Basic characterization of included subjects. Parameters 2011 2014 2018 Total Socio-demographic characteristics Age (years) 65–74 1563 (20.1%) 812 (17.4%) 2091 (23.0%) 4466 (20.7%) 75–84 2104 (27.1%) 1619 (34.7%) 2343 (25.8%) 6066 (28.2%) 85–94 2229 (28.7%) 1312 (28.1%) 2178 (24.0%) 5719 (26.6%) ≥95 1875 (24.1%) 924 (19.8%) 2478 (27.2%) 5277 (24.5%) Gender Male 3444 (44.3%) 2157 (46.2%) 3789 (41.7%) 9390 (43.6%) Female 4327 (55.7%) 2510 (53.8%) 5301 (58.3%) 12138 (56.4%) Duration of formal education 0 year 4525 (58.2%) 2534 (54.3%) 4731 (52.0%) 11790 (54.8%) 1−6 years 2354 (30.3%) 1548 (33.2%) 2861 (31.5%) 6763 (31.4%) 7−9 years 488 (6.3%) 348 (7.4%) 753 (8.3%) 1589 (7.4%) ≥10 years 404 (5.2%) 237 (5.1%) 745 (8.2%) 1386 (6.4%) Residential area Urban 3841 (49.4%) 2398 (51.4%) 4863 (53.5%) 11102 (51.6%) Rural 3930 (50.6%) 2269 (48.6%) 4227 (46.5%) 10426 (48.4%) Marital status Without spouse 4759 (61.2%) 2694 (57.7%) 5424 (59.7%) 12877 (59.8%) With spouse 3012 (38.8%) 1973 (42.3%) 3666 (40.3%) 8651 (40.2%) Number of children 4.5 (2.0) 4.4 (1.9) 4.4 (1.9) 4.2 (2.0) Income ≤30000 5245 (67.5%) 2755 (59.0%) 5417 (59.6%) 13417 (62.3%) 30,001–50,000 1024 (13.2%) 711 (15.3%) 1485 (16.3%) 3220 (15.0%) 50,001–100,000 1352 (17.4%) 1073 (23.0%) 1818 (20.0%) 4243 (19.7%) >100,000 150 (1.9%) 128 (2.7%) 370 (4.1%) 648 (3.0%) Lifestyle habits Smoke No 6338 (82.2%) 3862 (82.8%) 7724 (85.0%) 17974 (83.5%) Yes 1383 (17.8%) 805 (17.2%) 1366 (145.0%) 3554 (16.5%) Drinking alcohol No 6454 (83.1%) 3929 (84.2%) 7804 (85.9%) 18187 (84.5%) Yes 1317 (16.9%) 738 (15.8%) 1286 (14.1%) 3341 (15.5%) Exercise No 5070 (65.2%) 3282 (70.3%) 6498 (71.5%) 14850 (69.0%) Yes 2701 (34.8%) 1385 (29.7%) 2592 (28.5%) 6678 (31.0%) Health status Hearing impairment No 4120 (53.0%) 2754 (59.0%) 5352 (58.9%) 12226 (56.8%) Yes 3651 (47.0%) 1913 (41.0%) 3738 (41.1%) 9302 (43.2%) Self-reported health Bad 1769 (22.8%) 978 (21.0%) 1875 (20.6%) 4622 (21.5%) Moderate 2689 (34.6%) 1780 (38.1%) 3292 (36.2%) 7761 (36.1%) Good 3313 (42.6%) 1909 (40.9%) 3923 (43.2%) 9145 (42.4%) Chronic disease No chronic disease 3127 (40.2%) 1638 (35.1%) 3324 (36.5%) 8089 (37.6%) One chronic disease 1964 (25.3%) 1243 (26.6%) 2678 (29.5%) 5885 (27.3%) Multiple chronic diseases 2680 (34.5%) 1786 (38.3%) 3088 (34.0%) 7554 (35.1%) Depression No 7266 (93.5%) 4404 (94.4%) 7118 (78.3%) 18788 (87.3%) Yes 505 (6.5%) 263 (5.6%) 1972 (21.7%) 2740 (12.7%) ADL No disability 5751 (74.0%) 3572 (76.5%) 6787 (74.7%) 16110 (74.8%) Low disability 1295 (16.7%) 718 (15.4%) 1398 (15.3%) 3411 (15.9%) High disability 725 (9.3%) 377 (8.1%) 905 (10.0%) 2007 (9.3%) Social security Participation in insurance No 1381 (17.8%) 857 (18.4%) 1685 (18.5%) 3923 (18.2%) Yes 6390 (82.2%) 3810 (81.6%) 7405 (81.5%) 17605 (81.8%) Community services No 3867 (49.8%) 1875 (40.2%) 3478 (38.3%) 9220 (42.8%) Yes 3904 (50.2%) 2792 (59.8%) 5612 (61.7%) 12308 (57.2%) Observations 7771 4667 9090 21528 Table 2. Intergenerational support and cognitive function among older adults. Parameters 2011 2014 2018 Total Intergenerational financial support None 1311 (16.9%) 669 (14.3%) 1656 (18.2%) 3636 (16.9%) Provided alone 266 (3.4%) 211 (4.5%) 379 (4.2%) 856 (4.0%) Received alone 4120 (53.0%) 1902 (40.8%) 3666 (40.3%) 9688 (45.0%) Two-way 2074 (26.7%) 1885 (40.4%) 3389 (37.3%) 7348 (34.1%) Intergenerational caregiving support None 723 (9.3%) 361 (7.7%) 896 (9.9%) 1980 (9.2%) Provided alone 1589 (20.4%) 820 (17.6%) 2048 (22.5%) 4457 (20.7%) Received alone 2737 (35.2%) 1543 (33.1%) 3281 (36.1%) 7561 (35.1%) Two-way 2722 (35.0%) 1943 (41.6%) 2865 (31.5%) 7530 (35.0%) Intergenerational emotional support None 2223 (28.6%) 1138 (24.4%) 1987 (21.9%) 5348 (24.8%) Two-way 5548 (71.4%) 3529 (75.6%) 7103 (78.1%) 16180 (75.2%) Cognitive function No impairment 5018 (64.6%) 3261 (69.9%) 5885 (64.7%) 14164 (65.8%) Mild impairment 1085 (14.0%) 593 (12.7%) 1253 (13.8%) 2931 (13.6%) Moderate impairment 742 (9.5%) 374 (8.0%) 852 (9.4%) 1968 (9.1%) Severe impairment 926 (11.9%) 439 (9.4%) 1100 (12.1%) 2465 (11.5%) Observations 7771 4667 9090 21528 Table 3. Results of the regression model for the effect of intergenerational support on cognitive function among the older adults. Characteristic Coef. Intergenerational financial support , ref.: None Provided alone −0.164*** 0.063 Received alone −0.080*** 0.027 Two-way −0.197*** 0.029 Intergenerational caregiving support , ref.: None Provided alone −0.374*** 0.046 Received alone 0.112*** 0.040 Two-way −0.267*** 0.042 Intergenerational emotional support , ref.: None −0.241*** 0.024 Age (years), ref.: 65 – 74 75–84 0.343*** 0.040 85–94 0.733*** 0.041 ≥95 1.089*** 0.044 Gender , ref.: Male 0.222*** 0.025 Duration of formal education(years), ref.: 0 1−6 years −0.354*** 0.026 7−9 years −0.556*** 0.057 ≥10 years −0.358*** 0.053 Residential area, ref.: Urban 0.069*** 0.020 Marital status, ref.: without spouse −0.140*** 0.029 Income(yuan), ref.: ≤ 30000 30001–50000 −0.082*** 0.029 50001–100000 −0.037 0.026 >100000 −0.051 0.057 Smoke, ref.: No −0.035 0.031 Drinking alcohol , ref.: No −0.020 0.030 Exercise, ref.: No −0.158*** 0.024 Hearing impairment, ref.: No 0.536*** 0.020 Self-reported health, ref.: Bad Moderate −0.621*** 0.025 Good −0.801*** 0.027 Chronic disease, ref.: No chronic disease One chronic disease −0.107*** 0.024 Multiple chronic diseases −0.198*** 0.024 Depression, ref.: No −0.144*** 0.030 ADL, ref.: No disability Low disability 0.380*** 0.025 High disability 1.093*** 0.036 Participation in insurance, ref.: No 0.111*** 0.033 Community services, ref.: No −0.075*** 0.020 Year, ref.: 2011 2014 −0.030 0.027 2018 0.088*** 0.023 Note: *p≤0.1, **p≤0.05, ***p≤0.01 Table 4. Results of marginal effects. Cognitive function No cognitive impairment Mild cognitive impairment Moderate cognitive impairment Severe cognitive impairment Intergenerational financial support , ref.: None Provided alone 0.036*** (0.014) −0.009** (0.003) −0.009*** (0.003) −0.018*** (0.007) Received alone 0.018*** (0.006) −0.004 *** (0.001) −0. 004*** (0.001) −0.009 *** (0.003) Two-way 0.044*** (0.006) −0.011 *** (0.002) −0. 011*** (0.002) −0. 022*** (0.003) Intergenerational caregiving support , ref.: None Provided alone 0.086*** (0.011) −0. 024*** (0.003) −0. 023*** (0.003) −0.038 *** (0.005) Received alone −0.028 *** (0.010) 0.007*** (0.002) 0. 007*** (0.003) 0. 014*** (0.005) Two-way 0.063*** (0.010) −0.017*** (0.003) −0.017*** (0.003) −0.029*** (0.005) Intergenerational emotional support , ref.: None 0.053*** (0.005) −0.012*** (0.001) −0.013*** (0.001) −0.028*** (0.003) Note: *p≤0.1, **p≤0.05, ***p≤0.01 Table 5. Robust test based on IV-CMP. Oprobit Model IV-CMP Model Cognitive function IV: Number of children Cognitive function Atanhro_12 Intergenerational financial support , ref.: None Provided alone −0.164*** (0.063) 0.065*** (0.004) −0.451*** (0.057) 0.641*** (0.044) Received alone −0.080*** (0.027) −0.794*** (0.041) Two-way −0.197*** (0.029) −1.617*** (0.074) Intergenerational caregiving support , ref.: None Provided alone −0.374*** (0.046) 0.089*** (0.003) −0.605*** (0.043) 0.284*** (0.038) Received alone 0.112*** (0.040) −0.468*** (0.058) Two-way −0.327*** (0.043) −1.121*** (0.088) Intergenerational emotional support , ref.: None −0.241*** (0.024) 0.024*** (0.001) −1.047*** (0.062) 0.567*** (0.049) Control variables Control Control Control Control Note: *p≤0.1, **p≤0.05, ***p≤0.01 Table 6. Weak instrumental variable test. Intergenerational financial support Intergenerational caregiving support Intergenerational emotional support F-statistic 1282.81*** 1326.77*** 1991.74*** Minimum eigenvalue statistic 226.983 821.872 266.181 10% t hreshold 16.38 16.38 16.38 15% t hreshold 8.96 8.96 8.96 Note: *p≤0.1, **p≤0.05, ***p≤0.01 Additional Declarations No competing interests reported. Supplementary Files Supplementarytables.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 11 Feb, 2026 Reviewers invited by journal 13 Jun, 2025 Editor invited by journal 21 May, 2025 Editor assigned by journal 20 May, 2025 Submission checks completed at journal 20 May, 2025 First submitted to journal 14 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6667791","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":471470944,"identity":"2eab422c-80cf-4d3f-be75-11f45a1501f2","order_by":0,"name":"Sunxi Mao","email":"","orcid":"","institution":"Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Sunxi","middleName":"","lastName":"Mao","suffix":""},{"id":471470946,"identity":"0b3365c5-2b0b-4290-9eca-61ca87e01105","order_by":1,"name":"Tianyu Wang","email":"","orcid":"","institution":"Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Tianyu","middleName":"","lastName":"Wang","suffix":""},{"id":471470947,"identity":"ba216e2d-367b-4b5f-939b-6351c92a4e76","order_by":2,"name":"Xinyi Wang","email":"","orcid":"","institution":"Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xinyi","middleName":"","lastName":"Wang","suffix":""},{"id":471470948,"identity":"ec084897-79b5-4b06-bd2a-08d8a601ac03","order_by":3,"name":"Zinan Zhang","email":"","orcid":"","institution":"Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zinan","middleName":"","lastName":"Zhang","suffix":""},{"id":471470949,"identity":"0de96988-25ef-42c0-94be-e3270ae090b5","order_by":4,"name":"Zhonghua Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYFACHoYDEhUMzFA2cVoYH1icIVELs0FlG9xGIoDB+bPHJG7Ou8OuOyOB8cHbNgZ5c4JaDpxLk5y57Rmz2Y0EZsO5bQyGOxsIaDE72GMmLbntMEgLmzRvG0OCwQFCWg7zmEn/nQPWwv6bOC3HeIwNJBsgtjATpcX+DI/hA4ljQC1nHjZLzjknYbiBkBbJ/jMGByRqDiebHU8++OFNmY08QVtgIJmBgbEBSEsQqR4I7IhXOgpGwSgYBSMOAADK9j+4VbgAtQAAAABJRU5ErkJggg==","orcid":"","institution":"Nanjing Medical University","correspondingAuthor":true,"prefix":"","firstName":"Zhonghua","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-05-15 01:23:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6667791/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6667791/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84857230,"identity":"cc266b33-d8ce-4a9b-965a-a403e5055768","added_by":"auto","created_at":"2025-06-18 06:23:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":388574,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eResults of the marginal effects for estimating the urban−rural heterogeneity\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6667791/v1/a5c72e143047dd15f0920261.png"},{"id":84857231,"identity":"e5275ed0-998e-4985-818e-a4b56d5815b7","added_by":"auto","created_at":"2025-06-18 06:23:32","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":401588,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eResults of the marginal effects to for estimating the gender−based heterogeneity\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6667791/v1/448ab8e8e6c6665749042831.png"},{"id":84859356,"identity":"310b59a4-d3d2-4650-80aa-c81dad1e45ae","added_by":"auto","created_at":"2025-06-18 06:39:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2835166,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6667791/v1/b2193fa2-53c2-4169-ba20-fccc94477f50.pdf"},{"id":84856308,"identity":"6386c92e-e1d9-4901-97c7-4e900af079bf","added_by":"auto","created_at":"2025-06-18 06:15:32","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":18423,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarytables.docx","url":"https://assets-eu.researchsquare.com/files/rs-6667791/v1/1ae9a4b4482295f0d6f808ca.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Can Two-Way Intergenerational Support Better Protect Cognitive Function in Chinese Older Adults? A Nationally Representative Study ","fulltext":[{"header":"Background","content":"\u003cp\u003eRapid economic development is expected to gradually shift the global age structure from a pyramid to an olive shape [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Due to the acceleration of population aging in Japan, South Korea, and European countries, these regions will have evolved into some of the world's most super-aged areas by 2025. Data from China's Seventh Population Census (2020) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] suggest that the proportion of the population aged \u0026ge;65 increased by 4.63% between 2010 and 2020. This rise is 2.72% higher than the previous decade, it is anticipated that the degree of population ageing in China will continue to escalate in the future, surpassing the average level observed in developed countries [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe aging process is marked by a deterioration in functional capabilities and a weakening of social support networks for older adults [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Cognitive impairment is frequently highlighted as one of the most severe functional impairments experienced by older adults. It refers to a condition that significantly impacts essential functions such as learning, language acquisition, and memory retention. China has emerged as the country with the highest number of patients experiencing cognitive impairment worldwide. Approximately one in seven older people experience cognitive impairment, which significantly impacts the quality of life and the level of social engagement [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Therefore, with the growing aging population in China, the prevention and management of cognitive impairment in older adults has become a critical public health priority. In response, the \"Healthy China 2030\" initiative designates enhancing cognitive health and preventing or delaying the onset of cognitive impairments in older adults as key objectives. In this context, identifying protective factors against cognitive impairment in older adults and exploring the underlying mechanisms will aid in the prevention of cognitive decline, thereby contributing to healthy aging.\u003c/p\u003e \u003cp\u003eA large corpus of literature posits that social networks and social support are important for health in old age [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], and support from family and society exert a profound influence on cognitive function [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. As individuals age, their social support network tends to shrink, with external sources of support, such as relationships with coworkers and friends, gradually weakening. Consequently, the role of intergenerational support within the family becomes increasingly prominent [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. According to the traditional \"nurture-support\" feedback model [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], intergenerational support involves a reciprocal exchange, with support flowing both from the child to the parent and vice versa [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Intergenerational support takes two forms: one-way support, provided solely by either the offspring or the parent, and two-way support, involving reciprocal exchanges [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Furthermore, three main types of intergenerational support have been identified: financial, caregiving, and emotional support [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough existing research has explored the relationship between intergenerational support and cognitive function in older adults, significant limitations remain in this area. First, most of the existing studies have focused on the effects of a single specific type of intergenerational support on cognitive function. For example, older adults with financial support from their adult children are less likely to develop cognitive impairment [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. According to Sims et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], receiving financial support from children without the ability to make financial rewards may be negatively associated with cognitive performance in older people. Liao et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] revealed that moderate intensity and frequency of caregiving was associated with better cognitive function in a Chinese middle-aged and older population. Bon Sanga and Bordoneb [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] argued that informal care provided by children has a significant negative impact on mothers' cognitive function. Furthermore, Eisele et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] discovered that emotional support had no effect on cognition; the findings of Xu and Luo [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] confirmed that emotional support greatly contributed to the cognitive health of middle-aged and older parents. Despite existing literature exploring the relationship between various forms of intergenerational support and cognitive function, the field lacks a comprehensive analysis and comparative study of these different forms of support.\u003c/p\u003e \u003cp\u003eSecond, most existing research has focused on one-way intergenerational support.\u003c/p\u003e \u003cp\u003eIndeed, older adults with higher levels of family support from their children have better cognitive function and slower cognitive decline [\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Peng et al. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] revealed that receiving financial or caregiving support from children promoted cognitive performance in rural China. However, the provision of primary financial support by the offspring may also increase the risk of cognitive impairment in older adults [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Zwar et al. and Sharma et al. [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] collectively discovered that both sharing household chores and providing informal caregiving support to children can have a protective effect on the cognitive function of older adults, with a particular benefit observed female caregivers. Older parents who provide support to their children are more likely to have cognitive impairment because informal caregivers are under more stress than non-caregivers [\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Although previous research has investigated the effect of intergenerational support on cognitive function in older adults, limited attention has been given to the reciprocal nature of intergenerational support. Two-way intergenerational support, characterized by the reciprocal exchange of resources and emotions, may exert a more pronounced influence on cognitive health in older adults by fostering intergenerational balance. Therefore, the association between two-way intergenerational support and cognitive function in older adults warrant further investigation.\u003c/p\u003e \u003cp\u003eIn summary, although some studies have explored the relationship between intergenerational support and cognitive function in older adults, they have not offered a comparative analysis of different types of intergenerational support. More importantly, there is a notable gap in the literature regarding the effect of two-way intergenerational support, as compared to one-way support, on cognitive function in older adults. In this study, based on a nationally representative survey from China, we first used the Ordered Probit (Oprobit) model and marginal effects to examine the effects of different types of two-way and one-way intergenerational support on cognitive function in older adults. Subsequently, we applied the Instrumental Variable with Conditional Mixed Process (IV-CMP) estimation method to test the robustness between intergenerational support and cognitive function. Finally, to account for potential differences between urban and rural areas in China, as well as gender disparities, we stratified the extracted data by geographic region and gender to analyze heterogeneity.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eData source\u003c/h2\u003e\n \u003cp\u003eThe data utilized in this study derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) [\u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e], which was conducted by Peking University and the Chinese Center for Disease Control and Prevention, spanning the years 2011, 2014, and 2018. In the survey, a random selection of half the total number of counties and cities from 22 Chinese provinces served as survey sites, thereby covering approximately 85% of the country\u0026apos;s population. Unequally proportional random sampling and multistage sampling methods were used to survey adults aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years. The original dataset consisted of 32,831 observations. After excluding cases with missing data, the final sample included 21,528 individuals: 7771 individuals in 2011, 4667 in 2014, and 9090 in 2018.The CLHLS dataset provides comprehensive data on demographics, family structure, economic status, lifestyle, intergenerational support, health, and cognitive function. Statistical analysis was performed using STATA software (v.14.0; STATA Corp., College Station, TX, USA).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eData analysis\u003c/h2\u003e\n \u003cp\u003eOrdered Probit model\u003c/p\u003e\n \u003cp\u003eThe dependent variable in this study is the cognitive function of older adults, which is measured on a discrete ordinal scale ranging from 0 to 3. 0, 1, 2, and 3 representing \u0026ldquo;No cognitive impairment,\u0026rdquo; \u0026ldquo;Mild cognitive impairment,\u0026rdquo; \u0026ldquo;Moderate cognitive impairment,\u0026rdquo; \u0026ldquo;Severe cognitive impairment,\u0026rdquo; respectively. Given the ordinal nature of the data, the Ordered Probit (Oprobit) model was deemed more appropriate for analysis, formulated as follows:\u003c/p\u003e\n \u003cdiv id=\"Equa\" class=\"Equation\"\u003e\n \u003cdiv class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e$$\\:{mmse}^{*}=F(\\alpha\\:+\\beta\\:{support}_{i}+\\gamma\\:{control}_{i}+{\\epsilon\\:}_{i})$$\u003c/div\u003e\n \u003c/div\u003e\n \u003cp\u003eWhere \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{mmse}^{*}\\)\u003c/span\u003e\u003c/span\u003erepresents the latent variable of cognitive function of the \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:i\\)\u003c/span\u003e\u003c/span\u003eth older adult; \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{support}_{i}\\)\u003c/span\u003e\u003c/span\u003e represents the intergenerational support, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{control}_{i}\\)\u003c/span\u003e\u003c/span\u003e represents a series of control variables including socio-demographic characteristics, lifestyle habits, health status and social security; and \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\epsilon\\:}_{i}\\)\u003c/span\u003e\u003c/span\u003e is the random error term. The function F(.) represents a nonlinear mapping. The coefficients of the Oprobit model denote the direction of change in the underlying latent variable rather than directly influencing the probability of the outcome. Consequently, these coefficients are not immediately interpretable, necessitating the computation of marginal effects to elucidate the impact of independent variables on the dependent variable. Marginal effects quantify the average shift in the dependent variable in response to a minute change in the independent variable, formulated as follows:\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u0026nbsp;\u003cspan class=\"mathinline\"\u003e\\(\\:ME\\left({support}_{i}\\right)=\\)\u003c/span\u003e\u0026nbsp;\u003c/span\u003e \u0026Phi;\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\left({\\beta\\:}_{0}+{\\beta\\:}_{1}{support}_{i}+{\\beta\\:}_{2}{control}_{i}+{\\sigma\\:}_{j}\\right)\u0026middot;\\varphi\\:\\left({\\beta\\:}_{0}+{\\beta\\:}_{1}{support}_{i}+{\\beta\\:}_{2}{control}_{i}+{\\sigma\\:}_{j-1}\\right)\u0026middot;{\\beta\\:}_{j-1}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u0026nbsp;\u003cspan class=\"mathinline\"\u003e\\(\\:ME\\left({support}_{i}\\right)\\)\u003c/span\u003e\u0026nbsp;\u003c/span\u003e represents the marginal effect of the independent variable \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{support}_{i}\\)\u003c/span\u003e\u003c/span\u003e and denotes the probability of change in the dependent variable \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{mmse}_{j}\\)\u003c/span\u003e\u003c/span\u003e across categories when \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{support}_{i}\\)\u003c/span\u003e\u003c/span\u003e is increased by one unit. \u0026Phi; is the cumulative distribution function of the standard normal distribution. \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\varphi\\:\\)\u003c/span\u003e\u003c/span\u003e is the probability density function of the standard normal distribution and \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:{\\sigma\\:}_{j}\\)\u003c/span\u003e\u003c/span\u003eis the delimitation threshold parameter, which is used to identify different categories of the dependent variable.\u003c/p\u003e\n \u003ch3\u003eRobust test model\u003c/h3\u003e\n \u003cp\u003eTo address endogeneity issues, including self-selection bias and collider bias in the Oprobit model, this study employed an Instrumental Variable with Conditional Mixed Process (IV-CMP) estimation method, as developed by Roodman [\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e], to ensure robust analysis. This approach optimizes the treatment effect of intergenerational support, verifies the causal relationship between intergenerational support and cognitive function, and provides more robust conclusions. IV-CMP requires prioritizing the identification of appropriate instrumental variables. To ensure their validity, we conducted a weak instrumental variable test for linear models to scrutinize the regression outcomes [\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eVariable selection\u003c/h3\u003e\n\u003ch3\u003eCognitive function\u003c/h3\u003e\n\u003cp\u003eThe Mini-Mental State Examination (MMSE) was employed to evaluate the cognitive function of the respondents. The MMSE consists of five dimensions: orientation, memory, attention and calculation, recall, and language ability, with a total of 30 items. The overall score ranges from 0\u0026ndash;30. Higher scores indicate better cognitive function. The level of cognitive function of older adults was categorized into four categories of cognitive based on MMSE international standards [\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e]: no impairment (24\u0026ndash;30 points), mild impairment (18\u0026ndash;23 points), moderate impairment (10\u0026ndash;17 points), and severe impairment (0\u0026ndash;9 points).\u003c/p\u003e\n\u003ch2\u003eIntergenerational support\u003c/h2\u003e\n\u003cp\u003eA total of three independent variables were established from the three types of intergenerational support:\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e(i) Intergenerational financial support\u003c/strong\u003e : The intergenerational financial support variable derived from the questionnaire items: \u0026quot;In the past year, how much money in cash (or in kind) did your children give you?\u0026quot; and \u0026quot;In the past year, how much money in cash (or in kind) did you give your children?\u0026quot; The responses to these questions were used to categorize the receipt and provision of financial support respectively. In our study, intergenerational financial support was categorized into four distinct classifications: \u0026ldquo;No support\u0026rdquo; if neither providing nor receiving exceeded \u003cspan\u003e$\u003c/span\u003e0 per year; \u0026ldquo;Provided financial support alone\u0026rdquo; if the older adult provided more than \u003cspan\u003e$\u003c/span\u003e0 per year but did not receive any support; \u0026ldquo;Received financial support alone\u0026rdquo; if the older adult received over \u003cspan\u003e$\u003c/span\u003e0 per year but did not provide any support; and \u0026ldquo;Two-way financial support\u0026rdquo; if the older adult both provided and received support exceeding \u003cspan\u003e$\u003c/span\u003e0 per year.\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e(ii) Intergenerational caregiving support\u003c/strong\u003e: The intergenerational caregiving support variable derived from the questionnaire items: \u0026quot;Who primarily cares for you when you are not feeling well or when you are sick?\u0026quot; and \u0026quot;Are you currently engaged/participated in any of the following activities? Such as housework (cooking, childcare, etc.)\u0026quot;. The responses to these questions were used to categorize the receipt and provision of caregiving support respectively. The receipt of caregiving support was categorized as \u0026quot;Yes\u0026quot; if the answer to the first question was children, grandchildren, or similar relatives, and \u0026quot;No\u0026quot; for all other responses. The provision of caregiving support was defined as \u0026quot;Yes\u0026quot; if the second question was answered affirmatively, and \u0026quot;No\u0026quot; in all other cases. Intergenerational caregiving support was classified into four categories: \u0026ldquo;No support,\u0026rdquo; defined as the absence of both providing and receiving care; \u0026ldquo;Provided caregiving support alone,\u0026rdquo; when the older adult provided childcare exclusively to their children; \u0026ldquo;Received caregiving support alone,\u0026rdquo; when the older adult received informal care exclusively from their children; and \u0026ldquo;Two-way caregiving support,\u0026rdquo; when the older adult both provided and received caregiving support.\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e\u003cstrong\u003e(iii) Intergenerational emotional support\u003c/strong\u003e: Intergenerational emotional support is inherently reciprocal and bidirectional [\u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e]. It was defined using the questionnaire item, \u0026quot;Who do you talk to the most in your spare time?\u0026quot; Responses were coded as \u0026quot;Intergenerational emotional support exists\u0026quot; if participants selected \u0026quot;son, daughter, daughter-in-law, son-in-law, grandchildren, or spouse,\u0026quot; and as \u0026quot;No intergenerational emotional support exists\u0026quot; for all other responses. Therefore, 0 signified the absence of intergenerational emotional support, whereas 1 indicated the presence of such support.\u003c/p\u003e\n\u003c/span\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eInstrumental variable selection in the IV-CMP model\u003c/h3\u003e\n\u003cp\u003eA valid instrumental variable in IV-CMP model must satisfy two fundamental conditions: it must be correlated with the endogenous explanatory variable and uncorrelated with the dependent variable. The instrumental variable selected for this study was the number of children, as identified in a previous study [\u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e]. Intergenerational support is strongly correlated with the number of children older adults have [\u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e]. A greater number of children can increase the demands on older parents to provide financial, caregiving, and emotional support. Meanwhile, older adults with more children are likely to receive greater resources and emotional support from their offspring. However, the number of children does not directly affect the cognitive function of older parents. Thus, it serves as a valid instrumental variable in our analysis. To test the validity of the instrumental variable, we used the weak instrumental variable method.\u003c/p\u003e\n\u003ch3\u003eOther control variables\u003c/h3\u003e\n\u003cp\u003eOther control variables included socio-demographic characteristics, lifestyle habits, health status and social security. Socio-demographic characteristics variables included age, gender, duration of formal education, residential area, marital status, and income. Income level was categorized based on annual household earnings as \u0026le;\u0026thinsp;30,000, 30,001\u0026ndash;50000, 50,001\u0026ndash;100000, and \u0026gt;\u0026thinsp;100,000 Yuan. Lifestyle habits variables included smoking, drinking, and daily exercise. Health status variables refer to hearing impairment, self-reported health, chronic disease, depression, and activities of daily living (ADL). ADL was assessed using the Katz scale [\u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e] and categorized into three groups based on scores: no, low, and high disability. Social security variables included participation in insurance and community services.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBasic characteristics of participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 provides a detailed description of the samples. Overall, 79.3% of individuals were aged\u0026nbsp;\u0026sup3;75 years and 43.6% of the participants were male. Half of the older adults (51.6%) lived in the urban areas and 86.2% of the participants reported\u0026nbsp;\u0026pound;6 years of formal education. Furthermore, more than half of the\u0026nbsp;participants had no spouse (59.8%), reported no hearing impairment (56.8%), and had an annual income\u0026nbsp; \u0026pound;30,000 Yuan (62.3%). Less than one-third participated in exercise (31.0%), and 83.5% and 84.5% of the participants were non-smokers and non-drinkers, respectively. Approximately 24.6% of the participants reported a disability, and more than half reported diagnosis with at least one chronic disease (62.4%). Furthermore, 12.7% of older adults in this study experienced symptoms of depression. The majority of participants in the sample (81.8%) have social insurance.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026lt;Insert Table 1\u0026gt;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntergenerational support and cognitive function among the older adults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 shows the status of intergenerational support and cognitive function. In terms of financial support, ~45.0% of older adults received financial support alone from their children, 4.0% provided financial support alone to their children, and 34.1% of older adults experienced a two-way financial support arrangement with their children. Regarding caregiving support, 20.7% of older adults provided caregiving alone to their children, 35.1% received caregiving alone from their children, and 35.0% of older adults engaged in two-way intergenerational caregiving.\u0026nbsp;With regard to intergenerational emotional support, 75.2% of older participants reported intergenerational emotional support with their children. As shown in Table 3, 34.2% of older adults in the sample experienced cognitive impairment. Specifically, 13.6%, 9.1%, and 11.5% of the older demographic exhibited mild, moderate, and severe cognitive impairment, respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026lt;Insert Table 2\u0026gt; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEffects of intergenerational support on cognitive function among the older adults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 shows the association between intergenerational support and cognitive function. After controlling for socio-demographic factors, older adults who provided financial support alone (Coef.=-0.164), received financial support alone (Coef.=-0.080), and engaged in two-way financial support with their children (Coef.=-0.197) were all significantly associated with a lower risk of cognitive impairment. Regarding intergenerational caregiving support, whose who had provided caregiving alone was significantly associated with a lower risk of cognitive impairment in older adults (Coef.=-0.374), as was two-way caregiving support (Coef.=-0.267). In contrast, having received caregiving alone was significantly associated with a higher risk of cognitive impairment in older adults (Coef.=0.112). Furthermore, a significant negative correlation between intergenerational emotional support and cognitive impairment was observed in older adults (Coef.=-0.241). Other socio-demographic factors, including age, gender, duration of formal education, residential area, marital status, exercise, hearing impairment, self-reported health, chronic disease, depression, ADL, having insurance, and community services, were significantly associated with cognitive function.\u003c/p\u003e\n\u003cp\u003eTable 4 summarizes the results of the marginal effects analysis, which revealed that intergenerational support had an effect on cognitive function. Older adults who provided financial support alone had less likelihood of mild, moderate, and severe cognitive impairment by 0.9%, 0.9%, and 1.8%, respectively. Similarly, having received financial support alone was associated with reductions in the likelihood of mild, moderate, and severe cognitive impairment by 0.4%, 0.4%, and 0.9%, respectively. In contrast, two-way financial support was more effective in reducing the risk of cognitive impairment, with reductions of 1.1%, 1.1%, and 2.2%, respectively. Regarding caregiving support, two-way caregiving support reduced the likelihood of mild, moderate, and severe cognitive impairment in older adults by 1.7%, 1.7%, and 2.9%, respectively. Having provided caregiving support alone was associated with a 2.4%, 2.3%, and 3.8% reduction in the likelihood of cognitive impairment, respectively. However, having received caregiving support alone had a detrimental effect, increasing the likelihood of mild, moderate, and severe cognitive impairment in older adults by 0.7%, 0.7%, and 1.4%, respectively. Furthermore, intergenerational emotional support reduced the likelihood of mild, moderate, and severe cognitive impairment by 1.2%, 1.3%, and 2.8%, respectively.\u003c/p\u003e\n\u003cp\u003e\u0026lt;Insert Table 3\u0026gt;\u003c/p\u003e\n\u003cp\u003e\u0026lt;Insert Table 4\u0026gt;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRobustness test based on the IV-CMP estimation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of the IV-CMP analysis provided robust evidence of the significant effect of intergenerational support on cognitive function (Table 5). The Atanhrho_12 parameters (0.641, 0.284, 0.567) were all significant at the 1% level, indicating that intergenerational financial, caregiving, and emotional support are endogenous variables, supporting the reliability of the IV-CMP model. The number of children correlated with all three endogenous variables (Financial: 0.065; Caregiving: 0.089; Emotional: 0.024), confirmed the validity of the instrumental variable in addressing endogeneity.\u003c/p\u003e\n\u003cp\u003eThe IV-CMP results revealed that intergenerational support\u0026mdash;both one-way and two-way\u0026mdash;significantly mitigated cognitive impairment. These findings were consistent with the Oprobit model analyses, except for the case of having received caregiving support alone, indicating the robustness of the results. The mitigating effects of intergenerational support on cognitive impairment in the IV-CMP model were as follows: provided financial support alone (-0.451), received financial support alone (-0.794), two-way financial support (-1.617), provided caregiving support alone (-0.605), received caregiving support alone (-0.468), two-way caregiving support (-1.121), and intergenerational emotional support (-1.047). In addition, we conducted the weak instrumental variable test(Table 6), the F-statistics for all columns were \u0026gt;10 and were considered significant at the 1% level (Financial: F=1282.81; Caregiving: F=1326.77; Emotional: F=1991.74); the Wald test also revealed that the smallest eigenvalue statistic exceeded the 10% critical value, providing strong evidence that the number of children is not a weak instrument.\u003c/p\u003e\n\u003cp\u003e\u0026lt;Insert Table 5\u0026gt;\u003c/p\u003e\n\u003cp\u003e\u0026lt;Insert Table 6\u0026gt;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHeterogeneity analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUrban-rural heterogeneity\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFigure 1 summarizes the urban-rural disparities in the marginal effect of intergenerational support on cognitive function in older adults. All the regression estimates were controlled for socio-demographic factors. The Chow test was used to examine differences in the formation coefficients (Chow test =2.89,\u0026nbsp;P＜0.01). Having provided financial support alone reduced the risk of mild, moderate, and severe cognitive impairment by 0.8%, 0.8%, and 1.6% in urban-living older adults, which was significantly lower than that in their rural counterparts (1.2%, 1.3%, and 2.5%, respectively), whereas having received financial support alone reduced the risk by 0.5%, 0.5%, and 1.1% in urban older adults but had no significant effect in rural populations. Two-way financial support reduced the risk of mild, moderate, and severe cognitive impairment by 1.3%, 1.2%, and 2.5% in urban older adults, which was significantly higher than that of their rural counterparts (0.8%, 0.9%, and 1.8%). Regarding intergenerational caregiving support, having provided caregiving support alone reduced the risk of moderate and severe cognitive impairment by 2.3% and 3.7% in urban older adults, significantly lower than in rural areas (2.5% and 4.1%). However, having received caregiving support alone increased the risk of mild, moderate, and severe cognitive impairment by 0.7%, 0.8%, and 1.4% in urban older adults, with no significant effect in rural counterparts. Two-way caregiving support reduced the risk of mild, moderate, and severe cognitive impairment by 1.5%, 1.4%, and 2.3%, respectively, in urban older adults, which was significantly lower than that in rural areas (2.0%, 2.1%, and 3.6%). In addition,\u0026nbsp;having received intergenerational emotional support significantly reduced the risk of moderate and severe cognitive impairment by 1.2% and 2.6%, respectively, in urban-living older adults, which was significantly lower than the rates observed in rural counterparts (1.4% and 3.0%).\u003c/p\u003e\n\u003cp\u003e\u0026lt;Insert Figure 1\u0026gt;\u003c/p\u003e\n\u003cp\u003eGender-based heterogeneity\u003c/p\u003e\n\u003cp\u003eFigure 2 presents findings supporting gender-based disparities in the marginal effect of intergenerational support on cognitive function among older adults (Chow test=9.26, p\u0026lt;0.01). Having provided financial support alone reduced the risk of mild, moderate, and severe cognitive impairment by 0.7%, 1.0%, and 2.5% in older females, with no significant effect observed in older men; a similar pattern was observed in adults having received financial support alone (0.5%, 0.7%, 1.9%, respectively). Two-way financial support reduced the risk of mild, moderate, and severe cognitive impairment by 0.8%, 0.6%, and 0.9% in older men, which was significantly lower than that observed in older women (0.9%, 1.4%, and 3.4%). Having provided caregiving support alone reduced the risk of moderate and severe cognitive impairment in older men by 1.7% and 2.3%, respectively, which was significantly lower than that observed in older women (2.8% and 5.2%). Having received caregiving support alone reduced the risk of mild, moderate, and severe cognitive impairment in older men by 1.0%, 0.8%, and 1.2%, respectively, whereas, in older women, it had no significant effect on mild or moderate impairment but increased the risk of severe cognitive impairment by 1.5%. Two-way caregiving support reduced the risk of moderate and severe cognitive impairment in older men by 1.2% and 1.6%, respectively, which was lower than the reductions observed in older women (2.1% and 4.1%, respectively). Similarly, intergenerational emotional support reduced the risk of moderate and severe cognitive impairment in older men by 1.0% and 1.7%, respectively, which were significantly lower than the corresponding reductions in women (1.4% and 3.8%).\u003c/p\u003e\n\u003cp\u003e\u0026lt;Insert Figure 2\u0026gt;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIntergenerational support plays a crucial role in mitigating cognitive impairment [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. However, the effect of two-way intergenerational support on cognitive function in older adults remains insufficiently understood. Our study conducted a comparative analysis of the effects of two-way and one-way intergenerational support on cognitive function among older Chinese adults. Additionally, robustness checks and heterogeneity analyses were performed, stratifying the data by geographic region and gender.\u003c/p\u003e \u003cp\u003eThe marginal effects analysis revealed that two-way financial support, two-way caregiving support, and intergenerational emotional support all had a significant mitigating effect on varying degrees of cognitive impairment risk, particularly for severe patients. These findings were further validated through robustness tests. Regarding one-way intergenerational support, having provided financial support alone, having received financial support alone, and having provided caregiving support alone were also significantly associated with a reduced risk of varying degrees of cognitive impairment. These findings aligned with existing research [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Therefore, fostering intergenerational support may be an effective strategy for mitigating cognitive impairment risk in older adults. Furthermore, our study found that two-way financial support was more effective than one-way support in reducing the risk of cognitive impairment of varying degrees. This result supports the view that reciprocal financial exchanges involves not only the transfer of financial resources but also fosters a sense of mutual responsibility and contribution, as well as active communication and engagement between the giver and the receiver [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. This reciprocal interaction may play a more effective protective role in preserving cognitive health in older adults. In contrast, although receiving or providing financial support alone may reduce the risk of cognitive impairment in older adults, it offers less interaction and feedback, thereby limiting its protective effects on cognitive function [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Hence, strategies that encourage reciprocal financial exchanges between older adults and their families, such as establishing a shared family financial support system, should be promoted to effectively enhance cognitive well-being for older adults.\u003c/p\u003e \u003cp\u003eUnexpectedly, two-way caregiving support had a weaker effect on reducing the risk of cognitive impairment in older adults compared with having provided caregiving support alone in older adults. Two-way caregiving involves frequent role switching and responsibility sharing, requiring older adults to alternate between being caregivers and care recipients. This role conflict may lead to distraction and depletion of cognitive resources [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], which could diminish the protective effect of intergenerational support on cognitive impairment. In contrast, previous studies have shown that when older adults provided caregiving alone to their children, the roles were clearer and tasks more defined, allowing for better cognitive resource allocation[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Moreover, when older adults provide caregiving alone, it may maximize their self-worth and sense of accomplishment [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], thereby better supporting cognitive health. Our findings also indicated that emotional support, as a form of two-way intergenerational support, was also significantly associated with a reduced risk of cognitive impairment in older adults, particularly for severe cases, which is in agreement with a previous report [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Therefore, targeted interventions should promote intergenerational emotional support through family engagement, strengthening family cohesion, enhancing emotional bonds, and reducing risk of cognitive impairment.\u003c/p\u003e \u003cp\u003e Our findings indicate that, among the three types of two-way intergenerational support, two-way caregiving support exhibited the most significant mitigating effect on the risk of cognitive impairment by varying degrees in older adults, although two-way financial support had the weakest effect. This may be attributed to the fact that, in contrast with financial support, two-way caregiving support requires more direct involvement in the daily lives of older adults. It not only addresses their physical needs but also fosters meaningful interactions between caregivers and recipients. Providing and receiving caregiving requires problem-solving, decision-making, and active communication [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], which play a crucial role in promoting mental well-being and preserving cognitive function in older adults. Meanwhile, having provided caregiving support alone had the most significant effect on mitigating the risk of cognitive impairment among the three types of one-way intergenerational support. It also demonstrated a stronger effect on reducing cognitive impairment risk compared with the two-way caregiving support, as noted above. Therefore, interventions to prevent cognitive impairment should prioritize encouraging older adults to assume appropriate caregiving responsibilities and promote reciprocal caregiving relationships, as these may enhance cognitive engagement, emotional connection, and social interaction.\u003c/p\u003e \u003cp\u003eRural China is typically characterized by multigenerational family structures and close intergenerational bonds, whereas urban areas increasingly consist of smaller, more variable nuclear family units [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Our findings indicate that rural older adults may derive greater cognitive benefits from providing financial support alone to their offspring compared with their urban counterparts, which is consistent with previous studies [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Meanwhile, having received financial support alone had no significant effect on adult cognition in rural areas. Given the more homogeneous social structures and traditional cultural norms in rural China, such as filial piety, patriarchal family structure, and family collectivism [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], older adults living in a rural setting may view providing\u0026mdash;rather than receiving\u0026mdash;financial support as a key way to affirm their social value and autonomy, which may contribute to a greater sense of self-worth and, in turn, result in enhanced cognitive benefits. However, our study showed that two-way financial support acted a stronger protective factor against cognitive impairment among urban older adults than among their rural counterparts. This may be due to the weaker influence of traditional norms in urban areas [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], where both providing and receiving financial support benefit cognition health. Additionally, urban environments offer better healthcare access, social participation, and promotion of healthy behavior [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e], enhancing the efficacy of intergenerational financial support in protecting cognitive health. In terms of intergenerational caregiving support, our findings revealed that both two-way caregiving support and providing caregiving alone were more effective in reducing the risk of cognitive impairment among rural older adults than that among their urban counterparts. A possible explanation is that multigenerational family structures, stronger intergenerational ties, and traditional caregiving roles in rural China provide a greater sense of fulfillment and family engagement [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], which better protects the cognitive health of older adults. Finally, our study indicates that intergenerational emotional support was linked to a reduced risk of moderate and severe cognitive impairment in both urban and rural areas, with a stronger impact on in rural settings. This finding may be attributed to the relatively stable family structures, stronger intergenerational ties, deeper cultural continuity, and reduced environmental stress present in rural communities [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e], which together enhance the buffering effects of emotional support on cognitive impairment.\u003c/p\u003e \u003cp\u003eRegarding gender disparities on the effects of intergenerational support on cognitive function among older adults, our study found that two-way financial support was more beneficial for women than men, especially in reducing the risk of moderate and severe cognitive impairment. Meanwhile, both providing and receiving financial support alone have stronger effects on reducing the risk of cognitive impairment in older women than those in older men, which is in accordance with previous studies [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. In addition, both caregiving support\u0026mdash;whether provided alone or two-way\u0026mdash;and intergenerational emotional support showed stronger protective effects among older women than men, especially in reducing moderate and severe cognitive impairment risk, which contrasts with the findings of recent research [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. These gender-based disparities may stem from the traditional caregiving role of the woman, stronger emotional engagement in family relationships, greater sensitivity to reciprocity, and heightened psychological gains from support exchanges [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. These factors may enhance their sense self-worth and emotional well-being, thereby contributing more significantly to cognitive health. Therefore, it is essential to implement gender-based sensitive strategies that promote flexible caregiving roles, challenge traditional gender-based norms, and ensure access to mental health support, thereby enabling both men and women to fully benefit from intergenerational support and maintain cognitive health in later life.\u003c/p\u003e \u003cp\u003eOur study was subject to certain limitations that should be acknowledged. Firstly, the absence of unified criteria for selecting measurement indicators in current research on intergenerational support may constrain the generalizability and comparability of our findings. Additionally, the reliance on self-reported data in the questionnaire design introduces the potential for recall bias, which may compromise the accuracy and validity of the data. Thirdly, the selection of control variables may lack sufficient comprehensiveness, potentially limiting the scope and robustness of the study findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study suggested that in China, two-way financial, caregiving, and emotional support significantly reduced the risk of cognitive impairment, especially for more severe patients. Moreover, two-way financial support was more effective than one-way support in reducing the risk of cognitive impairment by varying degrees. However, two-way caregiving support had a weaker effect on reducing cognitive impairment risk in older adults compared with having provided caregiving support alone. Furthermore, our data showed that two-way caregiving had the strongest effect in reducing the risk of cognitive impairment among the three types of two-way intergenerational support, whereas two-way financial support had the weakest. Finally, our findings revealed disparities in the effect of intergenerational support on cognitive function comparing older adults from rural and urban areas and between men and women; this provides a scientific basis for designing tailored intervention strategies to address cognitive impairment risks in different demographic groups.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eOprobit \u0026nbsp; \u0026nbsp;Ordered Probit\u003c/p\u003e\n\u003cp\u003eIV-CMP \u0026nbsp; Instrumental Variable with Conditional Mixed Process\u003c/p\u003e\n\u003cp\u003eCLHLS \u0026nbsp; Chinese Longitudinal Healthy Longevity Survey\u003c/p\u003e\n\u003cp\u003eMMSE \u0026nbsp; Mini-Mental State Examination\u003c/p\u003e\n\u003cp\u003eADL \u0026nbsp; Activities of Daily Living\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Academic Research Ethics Committee of Nanjing Medical University; reference number: 2022460. All procedures were in accordance with the ethical standards of the Helsinki Declaration. Participants provided informed consent prior to data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by National Natural Science Foundation of China (No.72374108). The funding bodies were not involved in the design of the study, or data collection, analysis, and interpretation or in writing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSunxi Mao: Leading the analysis of the data and writing the draft of the manuscript; Tianyu Wang: Participating in data analysis and writing; Xinyi Wang: Contributing to writing; Zinan Zhang and Zhonghua Wang: Contributing equally to the study design, interpretation of the data and helped in the writing of the final draft of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThanks to all participants for their support and assistance with our research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study utilized data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which is publicly available in the CLHLS repository, https://opendata.pku.edu.cn/dataset.xhtml?persistentId=doi:10.18170/DVN/WBO7LK\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eZhang H, Zhang H, Zhang J. Demographic age structure and economic development: evidence from chinese provinces. Journal of Comparative Economics. 2015;43:170\u0026ndash;85.\u003c/li\u003e\n\u003cli\u003eAkimov AV, Gemueva KA, Semenova NK. The seventh population census in the PRC: results and prospects of the country\u0026rsquo;s demographic development. Her Russ Acad Sci. 2021;91:724\u0026ndash;35.\u003c/li\u003e\n\u003cli\u003eThe Lancet. Population ageing in China: crisis or opportunity? Lancet. 2022;400:1821.\u003c/li\u003e\n\u003cli\u003eDeary IJ, Corley J, Gow AJ, Harris SE, Houlihan LM, Marioni RE, et al. Age-associated cognitive decline. Br Med Bull. 2009;92:135\u0026ndash;52.\u003c/li\u003e\n\u003cli\u003eCampos ACBF, Teixeira IG, Moraes N de S, Cadorin I de J, Morelli PM, Lidio AV, et al. Prevalence of cognitive impairment and associated factors in older people. J Affect Disord. 2024;355:283\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eR B, C H, Am A, Ab N, Kj M. Social networks, social support, and life expectancy in older adults: the Cardiovascular Health Study. Arch Gerontol Geriatr. 2023;111:104981.\u003c/li\u003e\n\u003cli\u003eJeon H, Chung Y, Chung S, Song A. The Influence of Social Networks and Social Support on Health Among Older Koreans at High Risk of Depression. Care Manag J. 2016;17:70\u0026ndash;80.\u003c/li\u003e\n\u003cli\u003eFan Z, Lv X, Tu L, Zhang M, Yu X, Wang H. Reduced social activities and networks, but not social support, are associated with cognitive decline among older chinese adults: a prospective study. Soc Sci Med (1982). 2021;289:114423.\u003c/li\u003e\n\u003cli\u003eSims RC, Hosey M, Levy S-A, Whitfield KE, Katzel LI, Waldstein SR. Distinct functions of social support and cognitive function among older adults. Exp Aging Res. 2014;40:40\u0026ndash;59.\u003c/li\u003e\n\u003cli\u003eLi C, Jiang S, Zhang X. Intergenerational relationship, family social support, and depression among Chinese elderly: A structural equation modeling analysis. J Affect Disord. 2019;248:73\u0026ndash;80.\u003c/li\u003e\n\u003cli\u003eFingerman KL, Sechrist J, Birditt K. Changing views on intergenerational ties. Gerontology. 2013;59:64\u0026ndash;70.\u003c/li\u003e\n\u003cli\u003eChen F, Liu G, Mair CA. Intergenerational Ties in Context: Grandparents Caring for Grandchildren in China. Soc Forces. 2011;90:571\u0026ndash;94.\u003c/li\u003e\n\u003cli\u003eWang P. The influence of intergenerational support on cognitive functioning among middle-aged Chinese: Moderation by personal income. Arch Gerontol Geriatr. 2024. https://doi.org/10.1016/j.archger.2024.105393.\u003c/li\u003e\n\u003cli\u003eLiao S, Qi L, Xiong J, Yan J, Wang R. Intergenerational Ties in Context: Association between Caring for Grandchildren and Cognitive Function in Middle-Aged and Older Chinese. Int J Environ Res Public Health. 2020;18:21.\u003c/li\u003e\n\u003cli\u003eYang Q, Jia J. Association of intergenerational relationships with cognitive impairment among Chinese adults 80 years of age or older: prospective cohort study. BMC Geriatr. 2022;22:838.\u003c/li\u003e\n\u003cli\u003eXu P, Burr JA, Kim K, Cong Z. Intergenerational financial exchange and cognitive impairment among older adults in China. Aging Ment Health. 2019;23:1209\u0026ndash;17.\u003c/li\u003e\n\u003cli\u003eDeng J, Hu J, Wu W, Dong B, Wu H. Subjective well-being, social support, and age-related functioning among the very old in China. Int J Geriatr Psychiatry. 2010;25:697\u0026ndash;703.\u003c/li\u003e\n\u003cli\u003eWang B, He P, Dong B. Association between family functioning and cognitive impairment among Chinese nonagenarians/centenarians. Geriatr Gerontol Int. 2015;15:1135\u0026ndash;42.\u003c/li\u003e\n\u003cli\u003eBonsang E, Bordone V. The Effect of Informal Care from Children on Cognitive Functioning of Older Parents. SSRN Electron J. 2013. https://doi.org/10.2139/ssrn.2251784.\u003c/li\u003e\n\u003cli\u003eM E, T Z, M K, B W, K H, F T, et al. Influence of social support on cognitive change and mortality in old age: results from the prospective multicentre cohort study AgeCoDe. BMC geriatrics. 2012;12.\u003c/li\u003e\n\u003cli\u003eXu Y, Luo Y. The Effect of Adult Children\u0026rsquo;s Education Attainment on Their Parents\u0026rsquo; Cognitive Health: An Intergenerational Support Perspective. Front Public Health. 2022;10:744333.\u003c/li\u003e\n\u003cli\u003eZhu S, Hu J, Efird JT. Role of social support in cognitive function among elders. J Clin Nurs. 2012;21:2118\u0026ndash;25.\u003c/li\u003e\n\u003cli\u003eKelly ME, Duff H, Kelly S, McHugh Power JE, Brennan S, Lawlor BA, et al. The impact of social activities, social networks, social support and social relationships on the cognitive functioning of healthy older adults: a systematic review. Syst Rev. 2017;6:259.\u003c/li\u003e\n\u003cli\u003ePing W, Bei G. A Longitudinal Study of the Effect of Intergenerational Support on Cognitive Function of Rural Elderly. Popul J. 2011.\u003c/li\u003e\n\u003cli\u003ePeng C, Burr JA, Han SH. Cognitive function and cognitive decline among older rural Chinese adults: the roles of social support, pension benefits, and medical insurance. Aging Ment Health. 2023;27:771\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eYang Q, Jia J. Association of intergenerational relationships with cognitive impairment among Chinese adults 80 years of age or older: prospective cohort study. BMC Geriatr. 2022;22:838.\u003c/li\u003e\n\u003cli\u003eZwar L, K\u0026ouml;nig H-H, Hajek A. The impact of different types of informal caregiving on cognitive functioning of older caregivers: Evidence from a longitudinal, population-based study in Germany. Soc Sci Med. 2018;214:12\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eSharma N, Chakrabarti S, Grover S. Gender differences in caregiving among family - caregivers of people with mental illnesses. World J Psychiatry. 2016;6:7.\u003c/li\u003e\n\u003cli\u003ePinquart M, S\u0026ouml;rensen S. Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis. Psychol Aging. 2003;18:250\u0026ndash;67.\u003c/li\u003e\n\u003cli\u003eLupien SJ, McEwen BS, Gunnar MR, Heim C. Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nat Rev Neurosci. 2009;10:434\u0026ndash;45.\u003c/li\u003e\n\u003cli\u003eMinkler M. Depression in grandparents raising grandchildren: results of a national longitudinal study. Arch Fam Med. 1997;6:445\u0026ndash;52.\u003c/li\u003e\n\u003cli\u003eCenter For Healthy Aging And Development Studies. The Chinese Longitudinal Healthy Longevity Survey (CLHLS)-Longitudinal Data（1998-2018）. 2020.\u003c/li\u003e\n\u003cli\u003eRoodman D. Fitting Fully Observed Recursive Mixed-process Models with cmp. The Stata Journal: Promoting communications on statistics and Stata. 2011;11:159\u0026ndash;206.\u003c/li\u003e\n\u003cli\u003eChyi H, Mao S. The Determinants of Happiness of China\u0026rsquo;s Elderly Population. J Happiness Stud. 2012;13:167\u0026ndash;85.\u003c/li\u003e\n\u003cli\u003eFolstein MF, Folstein SE, McHugh PR. \u0026ldquo;Mini-mental state\u0026rdquo;. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189\u0026ndash;98.\u003c/li\u003e\n\u003cli\u003eSommer S, Buhl HM. Intergenerational transfers: associations with adult children\u0026rsquo;s emotional support of their parents. J Adult Dev. 2018;25:286\u0026ndash;96.\u003c/li\u003e\n\u003cli\u003eBolin K, Lindgren B, Lundborg P. Informal and formal care among single-living elderly in Europe. Health Econ. 2008;17:393\u0026ndash;409.\u003c/li\u003e\n\u003cli\u003eZhang J, Li J, Li C, Wang J. The impact of intergenerational support on older adults\u0026rsquo; life satisfaction in China: Rural-urban differences. Healthc Rehabil. 2025;1:100011.\u003c/li\u003e\n\u003cli\u003eKatz S. STUDIES OF ILLNESS IN THE AGED. THE INDEX OF ADL: A STANDARDIZED MEASURE OF BIOLOGICAL AND PSYCHOSOCIAL FUNCTION. JAMA. 1963;185:914.\u003c/li\u003e\n\u003cli\u003eSharifi S, Babaei Khorzoughi K, Khaledi-Paveh B, Rahmati M. Association of intergenerational relationship and supports with cognitive performance in older adults: A systematic review. Geriatr Nur (Lond). 2023;52:146\u0026ndash;51.\u003c/li\u003e\n\u003cli\u003eShu Z, Xiao J, Dai X, Han Y, Liu Y. Effect of family \u0026ldquo;upward\u0026rdquo; intergenerational support on the health of rural elderly in China: evidence from chinese longitudinal healthy longevity survey. PLOS One. 2021;16:e0253131.\u003c/li\u003e\n\u003cli\u003eYoo L, Moon CS, Park I, Lee M, Choi GE. Dual caregiving burden for older parents and grandchildren in middle-aged and older adults: a concept analysis. J Korean Gerontol Nurs. 2023;25:335\u0026ndash;45.\u003c/li\u003e\n\u003cli\u003eAdam S, Bonsang E, Grotz C, Perelman S. Occupational activity and cognitive reserve: implications in terms of prevention of cognitive aging and alzheimer\u0026rsquo;s disease. Clin Interv Aging. 2013;8:377\u0026ndash;90.\u003c/li\u003e\n\u003cli\u003eLiu J. Ageing, migration and familial support in rural china. Geoforum. 2014;51:305\u0026ndash;12.\u003c/li\u003e\n\u003cli\u003eYuan X, Wang Q. A tentative study on differences and integration of sino-western filial piety culture. Asian Soc Sci. 2011;7:p97.\u003c/li\u003e\n\u003cli\u003eYan Y. Intergenerational intimacy and descending familism in rural north China. Am Anthropol. 2016;118:244\u0026ndash;57.\u003c/li\u003e\n\u003cli\u003eSarkar C, Webster C. Urban environments and human health: current trends and future directions. Curr Opin Environ Sustain. 2017;25:33\u0026ndash;44.\u003c/li\u003e\n\u003cli\u003eShi J. The evolvement of family intergenerational relationship in transition: mechanism, logic, and tension. J Chin Sociol. 2017;4:20.\u003c/li\u003e\n\u003cli\u003eWu X, Yuan Z. Understanding the socio-cultural resilience of rural areas through the intergenerational relationship in transitional china: case studies from guangdong. J Rural Stud. 2023;97:303\u0026ndash;13.\u003c/li\u003e\n\u003cli\u003eOkamoto K, Tanaka Y. Gender differences in the relationship between social support and subjective health among elderly persons in Japan. Prev Med. 2004;38:318\u0026ndash;22.\u003c/li\u003e\n\u003cli\u003eGlauber R. Gender differences in spousal care across the later life course. Res Aging. 2017;39:934\u0026ndash;59.\u003c/li\u003e\n\u003cli\u003eTavero IL, Garc\u0026iacute;a EG, Seda JM, Serrano RR, Cabrera IMC, Rodr\u0026iacute;guez AA. The gender perspective in the opinions and discourse of women about caregiving. Rev Esc Enferm USP. 2018;52:e03370.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e\u003cstrong\u003e．\u003c/strong\u003e\u003cstrong\u003eBasic characterization of included subjects.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e2011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocio-demographic characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e65\u0026ndash;74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1563 (20.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e812 (17.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2091 (23.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e4466 (20.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e75\u0026ndash;84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e2104 (27.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1619 (34.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2343 (25.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e6066 (28.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e85\u0026ndash;94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e2229 (28.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1312 (28.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2178 (24.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e5719 (26.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026ge;95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1875 (24.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e924 (19.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2478 (27.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e5277 (24.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e3444 (44.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2157 (46.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3789 (41.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e9390 (43.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e4327 (55.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2510 (53.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e5301 (58.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e12138 (56.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of formal education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e0 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e4525 (58.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2534 (54.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e4731 (52.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e11790 (54.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e1\u0026minus;6 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e2354 (30.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1548 (33.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2861 (31.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e6763 (31.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e7\u0026minus;9 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e488 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e348 (7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e753 (8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1589 (7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026ge;10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e404 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e237 (5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e745 (8.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1386 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidential area\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e3841 (49.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2398 (51.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e4863 (53.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e11102 (51.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e3930 (50.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2269 (48.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e4227 (46.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e10426 (48.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eWithout spouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e4759 (61.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2694 (57.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e5424 (59.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e12877 (59.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eWith spouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e3012 (38.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1973 (42.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3666 (40.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e8651 (40.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of children\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e4.5 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e4.4 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e4.4 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e4.2 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026le;30000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e5245 (67.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2755 (59.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e5417 (59.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e13417 (62.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e30,001\u0026ndash;50,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1024 (13.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e711 (15.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1485 (16.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3220 (15.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e50,001\u0026ndash;100,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1352 (17.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1073 (23.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1818 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e4243 (19.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u0026gt;100,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e150 (1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e128 (2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e370 (4.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e648 (3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLifestyle habits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoke\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e6338 (82.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3862 (82.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e7724 (85.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e17974 (83.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1383 (17.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e805 (17.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1366 (145.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3554 (16.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDrinking alcohol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e6454 (83.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3929 (84.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e7804 (85.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e18187 (84.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1317 (16.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e738 (15.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1286 (14.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3341 (15.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExercise\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e5070 (65.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3282 (70.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e6498 (71.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e14850 (69.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e2701 (34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1385 (29.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2592 (28.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e6678 (31.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHealth status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHearing impairment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e4120 (53.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2754 (59.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e5352 (58.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e12226 (56.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e3651 (47.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1913 (41.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3738 (41.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e9302 (43.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelf-reported health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eBad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1769 (22.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e978 (21.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1875 (20.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e4622 (21.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e2689 (34.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1780 (38.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3292 (36.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e7761 (36.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e3313 (42.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1909 (40.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3923 (43.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e9145 (42.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChronic disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eNo chronic disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e3127 (40.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1638 (35.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3324 (36.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e8089 (37.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eOne chronic disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1964 (25.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1243 (26.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2678 (29.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e5885 (27.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eMultiple chronic diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e2680 (34.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1786 (38.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3088 (34.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e7554 (35.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e7266 (93.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e4404 (94.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e7118 (78.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e18788 (87.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e505 (6.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e263 (5.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1972 (21.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2740 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eADL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eNo disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e5751 (74.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3572 (76.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e6787 (74.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e16110 (74.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eLow disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1295 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e718 (15.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1398 (15.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3411 (15.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eHigh disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e725 (9.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e377 (8.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e905 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2007 (9.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial security\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipation in insurance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1381 (17.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e857 (18.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1685 (18.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3923 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e6390 (82.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3810 (81.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e7405 (81.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e17605 (81.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCommunity services\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e3867 (49.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1875 (40.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3478 (38.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e9220 (42.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e3904 (50.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2792 (59.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e5612 (61.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e12308 (57.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eObservations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e7771\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e4667\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e9090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e21528\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Intergenerational support and cognitive function among older adults.\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2014\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2018\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntergenerational financial support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;1311 (16.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;669 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;1656 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;3636 (16.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eProvided alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;266 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;211 (4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;379 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;856 (4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eReceived alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;4120 (53.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;1902 (40.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;3666 (40.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;9688 (45.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eTwo-way\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2074 (26.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1885 (40.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3389 (37.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e7348 (34.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntergenerational caregiving support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;723 (9.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;361 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;896 (9.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;1980 (9.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eProvided alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;1589 (20.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;820 (17.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;2048 (22.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;4457 (20.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eReceived alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;2737 (35.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;1543 (33.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;3281 (36.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;7561 (35.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eTwo-way\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2722 (35.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1943 (41.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2865 (31.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e7530 (35.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntergenerational emotional support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2223 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1138 (24.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1987 (21.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e5348 (24.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eTwo-way\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e5548 (71.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3529 (75.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e7103 (78.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e16180 (75.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCognitive function\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eNo impairment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e5018 (64.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e3261 (69.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e5885 (64.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e14164 (65.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eMild impairment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1085 (14.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e593 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1253 (13.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2931 (13.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eModerate impairment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e742 (9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e374 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e852 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1968 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eSevere impairment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e926 (11.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e439 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e1100 (12.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e2465 (11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eObservations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e7771\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e4667\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e9090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e21528\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Results of the regression model for the effect of intergenerational support on cognitive function among the older adults.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003eCoef.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cimg width=\"13\" height=\"16\" src=\"https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1750165608.png\" alt=\"image\"\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntergenerational financial support\u003c/strong\u003e\u003cstrong\u003e, ref.: None\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eProvided alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.164***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eReceived alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.080***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eTwo-way\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.197***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntergenerational caregiving support\u003c/strong\u003e\u003cstrong\u003e, ref.: None\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eProvided alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.374***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eReceived alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.112***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eTwo-way\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.267***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntergenerational emotional support\u003c/strong\u003e\u003cstrong\u003e, ref.: None\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.241***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years),\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;ref.:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e65\u003c/strong\u003e\u003cstrong\u003e\u0026ndash;\u003c/strong\u003e\u003cstrong\u003e74\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e75\u0026ndash;84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.343***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e85\u0026ndash;94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.733***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026ge;95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e1.089***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;ref.:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.222***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of formal education(years),\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;ref.:\u003c/strong\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e1\u0026minus;6 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.354***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e7\u0026minus;9 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.556***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026ge;10 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.358***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidential area,\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;ref.:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eUrban\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.069***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status,\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;ref.:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ewithout spouse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.140***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome(yuan),\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;ref.:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e\u0026le;\u003c/strong\u003e\u003cstrong\u003e30000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e30001\u0026ndash;50000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.082***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e50001\u0026ndash;100000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026gt;100000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoke,\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;ref.:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDrinking alcohol\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;ref.:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExercise,\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;ref.:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.158***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHearing impairment,\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;ref.:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.536***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelf-reported health,\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;ref.:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eBad\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.621***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eGood\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.801***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChronic disease,\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;ref.:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eNo chronic disease\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eOne chronic disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.107***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eMultiple chronic diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.198***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression,\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;ref.:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eNo\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.144***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eADL,\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;ref.:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eNo disability\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eLow disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.380***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eHigh disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e1.093***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipation in insurance,\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;ref.:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eNo\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.111***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCommunity services,\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;ref.:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.075***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYear,\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;ref.:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026minus;0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.088***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: *p\u0026le;0.1, **p\u0026le;0.05, ***p\u0026le;0.01\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Results of marginal effects.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"90%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCognitive function\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo cognitive impairment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMild cognitive impairment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate cognitive impairment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSevere cognitive impairment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntergenerational financial support\u003c/strong\u003e\u003cstrong\u003e, ref.: None\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eProvided alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.036*** (0.014)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026minus;0.009** (0.003)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026minus;0.009*** (0.003)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026minus;0.018*** (0.007)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eReceived alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.018*** (0.006)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026minus;0.004 *** (0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026minus;0. 004*** (0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026minus;0.009 *** (0.003)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eTwo-way\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.044*** (0.006)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026minus;0.011 *** (0.002)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026minus;0. 011*** (0.002)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026minus;0. 022*** (0.003)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntergenerational caregiving support\u003c/strong\u003e\u003cstrong\u003e, ref.: None\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eProvided alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.086*** (0.011)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026minus;0. 024*** (0.003)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026minus;0. 023*** (0.003)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026minus;0.038 *** (0.005)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eReceived alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026minus;0.028 *** (0.010)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.007*** (0.002)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0. 007*** (0.003)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0. 014*** (0.005)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eTwo-way\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.063*** (0.010)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026minus;0.017*** (0.003)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026minus;0.017*** (0.003)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026minus;0.029*** (0.005)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntergenerational emotional support\u003c/strong\u003e\u003cstrong\u003e, ref.: None\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.053*** (0.005)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026minus;0.012*** (0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026minus;0.013*** (0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026minus;0.028*** (0.003)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: *p\u0026le;0.1, **p\u0026le;0.05, ***p\u0026le;0.01\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Robust test based on IV-CMP.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"98%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 339px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOprobit Model\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 428px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIV-CMP Model\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 339px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eCognitive function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003eIV: Number of children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eCognitive function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003eAtanhro_12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 919px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntergenerational financial support\u003c/strong\u003e\u003cstrong\u003e, ref.: None\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eProvided alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u0026minus;0.164*** (0.063)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.065*** (0.004)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026minus;0.451*** (0.057)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.641*** (0.044)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eReceived alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u0026minus;0.080*** (0.027)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026minus;0.794*** (0.041)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eTwo-way\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 152px;\"\u003e\n \u003cp\u003e\u0026minus;0.197*** (0.029)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026minus;1.617*** (0.074)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 919px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntergenerational caregiving support\u003c/strong\u003e\u003cstrong\u003e, ref.: None\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eProvided alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003e\u0026minus;0.374*** (0.046)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.089*** (0.003)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026minus;0.605*** (0.043)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0.284*** (0.038)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eReceived alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003e0.112*** (0.040)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026minus;0.468*** (0.058)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003eTwo-way\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003e\u0026minus;0.327*** (0.043)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026minus;1.121*** (0.088)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 339px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntergenerational emotional\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003esupport\u003c/strong\u003e\u003cstrong\u003e, ref.: None\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003e\u0026minus;0.241*** (0.024)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e0.024*** (0.001)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026minus;1.047*** (0.062)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e0.567*** (0.049)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 339px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 152px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 186px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: *p\u0026le;0.1, **p\u0026le;0.05, ***p\u0026le;0.01\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eWeak instrumental variable test.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntergenerational financial support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntergenerational caregiving support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntergenerational emotional support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF-statistic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e1282.81***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e1326.77***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1991.74***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMinimum eigenvalue statistic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e226.983\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e821.872\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e266.181\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10%\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003et\u003c/strong\u003e\u003cstrong\u003ehreshold\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e16.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e16.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e16.38\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15%\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003et\u003c/strong\u003e\u003cstrong\u003ehreshold\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003e8.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 23px;\"\u003e\n \u003cp\u003e8.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e8.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: *p\u0026le;0.1, **p\u0026le;0.05, ***p\u0026le;0.01\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"One-way intergenerational support, Two-way intergenerational support, Cognitive impairment, Ordered Probit, Conditional Mixed Process","lastPublishedDoi":"10.21203/rs.3.rs-6667791/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6667791/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Intergenerational support plays a vital role in maintaining cognitive health among older adults. However, whether two-way intergenerational support offers greater protection of cognitive function compared with one-way support—either provided or received—remains poorly understood.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Data were obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS, 2011-2018). An Ordered Probit (Oprobit) model was used to estimate the effect of intergenerational support on cognitive function. Robustness was assessed using the Instrumental Variables with Conditional Mixed Process (IV-CMP) method, and heterogeneity was examined by stratifying the data by residence and gender.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Two-way financial, caregiving, and emotional support significantly reduced the risk of cognitive impairment in older adults, particularly in severe cases. Two-way financial support was more effective than either support provided or received alone in reducing the risk of cognitive impairment, whereas two-way caregiving was less effective than providing caregiving support alone. Among the three types of two-way intergenerational support, two-way caregiving demonstrated the strongest protective effect against cognitive impairment in older adults, whereas two-way financial support exhibited the weakest. Finally, notable rural–urban and gender disparities were observed to influence intergenerational support on the risk of cognitive impairment, underscoring the need for targeted interventions to address cognitive decline across diverse demographic groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The study highlights the protective effects of two-way intergenerational support on cognitive function among older Chinese adults and reveals variations across support types and demographic groups. The findings offer invaluable insights for promoting cognitive health in older adults.\u003c/p\u003e","manuscriptTitle":"Can Two-Way Intergenerational Support Better Protect Cognitive Function in Chinese Older Adults? A Nationally Representative Study ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-18 06:15:27","doi":"10.21203/rs.3.rs-6667791/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-11T11:57:22+00:00","index":"","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-13T06:47:25+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-21T09:23:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-20T06:12:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-20T06:08:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-05-15T01:19:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"02bc22e7-aaf9-4666-ac80-584474bce2a6","owner":[],"postedDate":"June 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-02-27T14:42:05+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-18 06:15:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6667791","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6667791","identity":"rs-6667791","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}