Relationship between cognitive factors, religiosity, fear of death and quality of life in community older adults

Relationship between cognitive factors, religiosity, fear of death and quality of life in community older adults | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Relationship between cognitive factors, religiosity, fear of death and quality of life in community older adults Jonil Marques Silva, Erivaldo Machado Araújo, Filipe Manuel Clemente, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6888781/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and Objectives: Religiosity has been associated with various psychosocial outcomes in older adults, including cognitive function, quality of life (QoL), and attitudes toward death. However, the interplay among these variables remains underexplored. This study aimed to examine the relationships between religiosity, cognitive performance, fear of death, and QoL in community-dwelling older adults. Methods: An analytical cross-sectional study was conducted with 105 older adults from a senior community center in Cuiabá, Brazil. Cognitive function was assessed using the Mini-Mental State Examination, Verbal Fluency Test, and Trail Making Test. Religiosity was measured via the Duke University Religion Index, fear of death using the Death Anxiety Questionnaire, and QoL with the WHOQOL-OLD. Spearman’s correlations evaluated associations among variables. Results: Participants demonstrated high religiosity and moderate death anxiety. Weak, positive correlations were observed between intrinsic religiosity and MMSE (r=0.28, p=0.04) and verbal fluency (r=0.22, p=0.02). Non-organizational religiosity was positively associated with verbal fluency (r=0.38, p=0.01) and overall QoL (r=0.20, p=0.03). Death anxiety showed a weak, negative correlation with QoL (r=-0.22, p=0.02). Advancing age was associated with poorer cognitive performance in verbal fluency (animals: r=-0.33, p=0.01; colors: r=-0.41, p=0.01) and reduced autonomy (r=-0.23, p=0.01). Discussion and Implications: Findings suggest that private and intrinsic religious engagement may support cognitive health and aspects of QoL in older adults, while organizational religiosity did not consistently correlate with well-being. The minimal association between religiosity and death anxiety challenges assumptions of a protective effect. These results underscore the value of integrating individualized spiritual considerations into gerontological interventions. Religiosity Cognitive Function Quality of Life Death Anxiety Older Adults INTRODUCTION Religiosity encompasses public and private religious practices, beliefs, and experiences, typically measured through organizational engagement, non-organizational activities, and subjective religiosity (Holman & Podrazik, 2018 ). It involves a personal relationship with God, manifested through religious awareness, feelings, decisions, community bonds, practices, morality, experiences, and faith profession (Walesa, 2020 ). Religiosity levels can be influenced by adversity, insecurity, or increased religious organizations (Bentzen, 2021 ). It impacts various socioeconomic outcomes, including traditional values, education, science, democracy, income, health, crime rates, and well-being (Bentzen, 2021 ). Religiosity, rooted in personal beliefs, can lead to complex behavioral adaptations and influence how individuals affect the emotions and perceptions of others. It shapes not only internal experiences but also interpersonal dynamics. For example, research exploring the relationship between religiosity and fear of death, as well as its impact on cognitive processes, has produced mixed findings (Florian & Mikulincer, 1993 ). These variations suggest that the influence of religiosity is nuanced and may depend on factors such as cultural context, individual belief systems, and the specific dimensions of religiosity being examined. Some studies found that religious individuals reported lower levels of death anxiety compared to non-religious counterparts (Florian & Mikulincer, 1993 ). However, other research indicated no significant connection between religiosity and fear of death (Démuthová, 2014 ). Factors such as cognitive and emotional susceptibility to mortality cues, as well as gender, were found to be stronger predictors of death anxiety than religiosity (French et al., 2017a ). For cancer patients, religiosity and time perspective played adaptive roles in coping with death fear and improving quality of life (Frolova, 2020 ). Age was also identified as a more important factor than religiosity in relation to fear of death (Démuthová, 2014 ). Research on the relationship between religiosity and death anxiety has yielded mixed results. Some studies found a negative correlation, with higher religiosity associated with lower death anxiety (Al-Sabwah & Abdel-Khalek, 2006 ; Hui & Coleman, 2013 ). However, others revealed a curvilinear relationship, where individuals with moderate religiosity exhibited higher death anxiety compared to those with low or high religiosity (Downey, 1984 ; Wen, 2012 ). Factors influencing this relationship include age, gender, and specific aspects of religiosity. Intrinsic religiosity was found to reduce death anxiety by fostering more positive afterlife beliefs and greater ego integrity in older adults (Hui & Coleman, 2013 ). Gender differences were observed, with females showing more fear of pain related to death (Wen, 2012 ). The relationship between religiosity and death anxiety may also be affected by situational variables and personal experiences with death (Al-Sabwah & Abdel-Khalek, 2006 ; Hui & Coleman, 2013 ). Research indicates a generally positive relationship between religiosity and quality of life (QoL). Multiple studies found that higher religiosity correlates with improved QoL in various populations, including breast cancer patients (Dewi et al., 2022 ) and elderly adults (Chaves et al., 2014 ). Religiosity often serves as a coping mechanism in adverse situations (Melo et al., 2015 ). However, the relationship is complex and context dependent. In dyads of individuals with dementia (IWDs) and their caregivers, caregivers' religiosity positively influenced IWDs' self-reported QoL, while IWDs' religiosity negatively affected caregivers' perceptions of IWDs' QoL (Nagpal et al., 2015 ). Some studies reported no association between religiosity and QoL(Dewi et al., 2022 ). Research indicates that religiosity can also positively influence cognitive factors across different populations. Kim et al. ( 2019 ) found that in patients with Alzheimer's disease, organizational and non-organizational religious activities were associated with improved memory and constructional abilities. Similarly, Egierd et al. ( 2021 ) reported that among older Chinese adults in Chicago, participation in organized religion predicted higher global cognitive function, particularly in working memory. In contrast, home religious practices showed no significant relationship with cognitive measures. Additionally, Vishkin et al. 2016 ) demonstrated that higher religiosity is linked to more effective use of cognitive reappraisal, an emotion regulation strategy, across various religious groups. Despite growing interest in the psychological and social implications of religiosity, there remains a significant gap in understanding how it simultaneously interacts with quality of life, fear of death, and cognitive functioning in a holistic view. Existing studies have often examined these variables in isolation or within narrowly defined populations, leading to fragmented and sometimes contradictory findings. Moreover, few studies have attempted to integrate these constructs into a comprehensive framework that considers their dynamic interrelationships. Given the potential of religiosity to serve as both a coping mechanism and a cognitive schema, it is critical to explore how it may buffer existential fears, enhance perceived well-being, and influence cognitive processes such as perception, memory, and decision-making. This study aims to bridge this gap by examining these relationships holistically, providing a more nuanced understanding of how belief systems shape human experience. Such insights are particularly relevant in multicultural and aging societies, where existential concerns and quality of life are increasingly prominent. MATERIALS & METHODS This study was approved by the Human Research Ethics Committee of the XXX , under protocol number 6.430.170. All procedures were conducted in accordance with the Declaration of Helsinki (466/2012). Prior to participation, all individuals received detailed information about the study and signed an informed consent form. Study Design This was an analytical cross-sectional study aimed at investigating the relationship between cognitive ability, fear of death, and religiosity with quality of life in community-dwelling older adults. The application of the tests to the participants selected as the sample occurred sequentially over two days. Cognitive ability was assessed using the Mini-Mental State Examination (MMSE), Verbal Fluency Test (VFT), and Trail Making Test (TMT); fear of death was evaluated using the Death Anxiety Questionnaire; religiosity was measured using the Duke University Religion Index; and quality of life was assessed using the World Health Organization Quality of Life Questionnaire for Older Adults (WHOQOL-OLD). Participants The sample consisted of older adults of both sexes attending the XXX . A convenience sampling procedure was adopted. Considering the population attending the center, a total of 114 older adults were identified, of whom 105 agreed to participate via direct contact and met the inclusion criteria of the study. The inclusion criteria were: (i) age 60 years or older; (ii) being community-dwelling; and (iii) having the minimum physical and cognitive abilities to participate in the interventions, such as being able to walk, sit and stand, hear commands, and respond verbally. Exclusion criteria included: (i) acute myocardial infarction or unstable angina within the past year; (ii) severe and uncontrolled systemic arterial hypertension; (iii) pneumothorax; (iv) pleurocutaneous or pulmonary fistulas; and (v) recent surgery or trauma involving the upper airways, chest, or abdomen. General Procedures During the data collection period, the older adults were assessed through a sequence of tests that examined the following variables: anamnesis, cognitive capacity, religiosity, fear of death, and quality of life. The selected participants were assessed in the morning, from 8:00 a.m. to 11:00 a.m., over two consecutive days. On the first day, a structured anamnesis was conducted, collecting sociodemographic and clinical information such as name, age, sex, race, marital status, occupation, educational level, comorbidities, and current medication use, and cognitive function was analyzed using three tests: the MMSE, VFT, and TMT. On the second day, the Duke University Religion Index, the Death Anxiety Questionnaire and the WHOQOL-OLD questionnaire were applied. Cognitive Function Mini-Mental State Examination (MMSE) The MMSE evaluates orientation, registration and short-term memory, attention, concentration, language (naming, sentence writing, and comprehension), and visuospatial skills. Individual items are summed to generate a total score, ranging from 0 to 30. Higher scores indicate greater global cognitive ability (D. M. de Melo & Barbosa, 2015 ). The test was divided into two parts. The first part assessed orientation, memory, and attention, with a maximum score of 21 points. The second part focused on specific skills such as naming and comprehension, with a maximum of 9 points. For evaluation purposes, the total score obtained by each participant was considered. Scores above 25 were interpreted as normal. Scores between 21 and 24 indicated suspected mild cognitive impairment; scores between 10 and 20, moderate impairment; and scores of 9 or below, severe impairment (Brucki et al., 2003 ). Verbal Fluency Test (VFT) Older adults were assessed using two semantic verbal fluency tests (animal and color categories). First, in the animal category fluency task, participants were asked to name as many animals as possible within one minute. In the color category fluency task, participants were asked to list as many colors as they could, also within a one-minute time limit (Troyer et al., 1997 ). One point was assigned for each unique animal or color named. Incorrect or repeated responses were not considered. The number of distinct items named during the task period represented the score for both test categories. Trail Making Test (TMT) The Trail Making Test evaluates visual attention, mental flexibility, and executive functioning. The test is divided into two parts: TMT-A: requires the participant to draw a line connecting numbers in ascending order (1–25); TMT-B: requires alternating between numbers and letters in sequence (1-A-2-B-3-C...). The participant’s performance is measured by the time taken to complete each task, with a time limit of 300 seconds for each part. Longer completion times indicate lower executive functioning (Mota et al., 2008 ). Religiosity Religiosity was assessed using the Duke University Religion Index (DUREL), which evaluates three dimensions of religious involvement: Organizational Religious Activity (OR): frequency of attending religious services; Non-Organizational Religious Activity (NOR): frequency of private religious activities such as prayer and meditation and; Intrinsic Religiosity (IR): degree of personal religious commitment or motivation. The instrument consists of five items —one for OR, one for NOR, and three for IR— scored on a Likert-type scale. Higher scores reflect greater levels of religiosity (Moreira-Almeida et al., 2008 ). Fear of Death The fear of death was measured using the Death Anxiety Questionnaire developed by Neimeyer and Moore (1994). The instrument consists of 26 items that assess attitudes, beliefs, and fears related to death, rated on a five-point Likert scale ranging from 1 ("strongly disagree") to 5 ("strongly agree"). The final score is the sum of the points from each item, with higher scores indicating higher levels of death anxiety (Neimeyer, 1994 ). Quality of Life Quality of life was assessed using the World Health Organization Quality of Life for Older Adults questionnaire (WHOQOL-OLD), adapted for the Brazilian population. This instrument comprises 24 items that evaluate different aspects of the lives of older adults, including sensory abilities, autonomy, satisfaction with past, present, and future activities, social participation, perceptions regarding death and dying, and intimacy. Each item is rated on a five-point Likert scale ranging from 1 to 5. The final score is calculated by averaging the scores of the different facets, with higher scores indicating a better perception of quality of life (Fleck et al., 2003 ). Statistical analysis Data analysis was conducted using SPSS software version 26.0, employing both descriptive and inferential statistical approaches. Frequency and percentage were used as descriptive measures for categorical variables. For numerical variables, data normality was initially assessed using the Shapiro-Wilk test. Since the data did not follow a normal distribution, the results were described using the median and interquartile range (Q1; Q3). Correlation analyses were performed to examine potential relationships between variables, employing Spearman’s correlation coefficient (Akoglu, 2018 ). A significance level of 5% (p < 0.05) was adopted. RESULTS The sociodemographic characteristics of the older adults are presented in Table 1 . Among all participants, the majority were female (84.7%), of mixed race (47.6%), had more than eight years of education (39.0%), and reported a diagnosis of systemic arterial hypertension (61.9%). The most frequently reported religious affiliations were Catholic (75.2%), Evangelical (13.3%), and Pentecostal (5.7%). Table 1 Distribution of sociodemographic and religious variables among older adults. Frequency % Sex Male 16 15.2 Female 89 84.7 Ethnicity Mixed race (Pardo) 50 47.6 Black 24 22.9 White 27 25.7 Indigenous 4 3.8 Education Level 0 to 3 years 34 32.4 4 to 8 years 30 28.6 More than 8 years 41 39.0 Diagnosed Conditions Hypertension (SAH) 65 61.9 Diabetes Mellitus (DM) 31 29.5 Other 19 18.1 Religious Affiliation Catholic 79 75.2 Evangelical 14 13.3 Pentecostal 6 5.7 Adventist 2 1.9 Jehovah’s Witness 1 1.0 Spiritism (Kardecist) 2 1.9 No affiliation 1 1.0 SAH = Systemic Arterial Hypertension; DM = Diabetes Mellitus The cognitive performance of the older adults in the present study is presented in Table 2 . The results showed that the average score on the MMSE was 23.2. The mean number of animals named in the verbal fluency test was 9.6, and the mean number of colors was 8.2. In the Trail Making Test A, participants took an average of 52.6 seconds to complete the task, while in Trail Making Test B, the average completion time was 59.3 seconds. Table 2 Cognitive performance of older adults. Median Q1–Q3 MMSE (points) 24.0 22.0–26.0 Verbal Fluency – Animals (n) 10.0 7.0–12.0 Verbal Fluency – Colors (n) 8.0 6.5–10.0 Trail Making Test A (sec) 60.0 47.5–60.0 Trail Making Test B (sec) 60.0 60.0–60.0 MMSE = Mini-Mental State Examination; TFV = Verbal Fluency Test; TMT = Trail Making Test. Table 3 presents the medians and interquartile ranges (Q1–Q3) of religiosity, death anxiety, and quality of life among the participants in the present study. The older adults exhibited high levels of organizational religiosity (mean: 4.8), non-organizational religiosity (mean: 4.7), and intrinsic religiosity (mean: 12.9). Additionally, the participants demonstrated moderate levels of death anxiety (mean: 55.5). Regarding quality of life, the domains with the lowest scores were intimacy (mean: 67.4) and autonomy (mean: 67.7), while the highest scores were observed in social participation (mean: 78.8). Table 3 Religiosity, death anxiety, and quality of life among older adults. Median Q1–Q3 Religiosity Organizational (OR) 5.0 4.0–6.0 Non-organizational (NOR) 5.0 5.0–5.0 Intrinsic (IR) 14.0 11.0–15.0 Death Anxiety Total DAS Score 41.0 38.0–45.0 DAS (%) 54.7 50.7–60.0 Quality of Life (%) Sensory Abilities 75.0 65.0–90.0 Autonomy 65.0 60.0–75.0 Past, Present, and Future Activities 80.0 72.5–80.0 Social Participation 80.0 75.0–85.0 Death and Dying 75.0 60.0–87.5 Intimacy 70.0 55.0–80.0 Overall Quality of Life 74.1 69.1–78.3 OR = Organizational Religiosity; NOR = Non-Organizational Religiosity; IR = Intrinsic Religiosity; DAS = Death Anxiety Scale. Table 4 presents the Spearman correlation matrix for the variables under investigation. Weak, negative, and statistically significant correlations were observed between age and the verbal fluency test (animals) (r = -0.33; p < 0.05), the verbal fluency test (colors) (r = -0.41; p < 0.05), and the autonomy domain of the WHOQOL-OLD (r = -0.23; p < 0.05). Weak, positive, and significant correlations were found between the MMSE and verbal fluency (animals) (r = 0.27; p < 0.05), verbal fluency (colors) (r = 0.35; p < 0.05), organizational religiosity (OR) (r = 0.38; p < 0.05), and intrinsic religiosity (IR) (r = 0.28; p < 0.05). Additionally, weak, negative, and significant correlations were observed between the MMSE and Trail Making Test A (r = -0.45; p < 0.05) and B (r = -0.34; p < 0.05). The verbal fluency test (animals) showed a weak, positive, and significant correlation with non-organizational religiosity (NOR) (r = 0.38; p < 0.05), intrinsic religiosity (IR) (r = 0.22; p < 0.05), the sensory abilities domain (r = 0.20; p < 0.05), autonomy (r = 0.27; p < 0.05), intimacy (r = 0.23; p < 0.05), and overall quality of life (r = 0.28; p < 0.05) from the WHOQOL-OLD. Negative correlations were found with Trail Making Test A (r = -0.25; p < 0.05) and B (r = -0.25; p < 0.05). The verbal fluency test (colors) showed weak, positive, and significant correlations with autonomy (r = 0.20; p < 0.05) and absolute power (r = 0.19; p < 0.05), as well as a weak, negative correlation with Trail Making Test B (r = -0.23; p < 0.05). Furthermore, death anxiety showed a weak, negative, and significant correlation with overall quality of life (r = -0.22; p < 0.05) on the WHOQOL-OLD. Organizational religiosity (OR) had a weak, positive, and significant correlation with Trail Making Test A (r = 0.25; p < 0.05) and a negative correlation with overall quality of life (r = -0.23; p < 0.05). Intrinsic religiosity (IR) showed a weak, negative, and significant correlation with the past, present, and future activities domain of the WHOQOL-OLD (r = -0.26; p < 0.05). The sensory abilities domain of the WHOQOL-OLD was weakly, negatively, and significantly correlated with Trail Making Test A (r = -0.23; p < 0.05). Social participation showed a positive correlation with Trail Making Test B (r = 0.30; p < 0.05) and a negative correlation with the clock-drawing test (r = -0.24; p < 0.05). Additionally, overall quality of life was weakly, positively, and significantly correlated with absolute power (r = -0.20; p < 0.05). Table 4 Religiosity, death anxiety, and quality of life in older adults. Age MMSE VFT Animals VFT Colors % DAS OR NOR IR SSF AUT PPF POS D&D INT TMT-A TMT-B MMSE -0,06 (0,48) - VF Animals -0,33 (0,01) 0,27 (0,05) - VF Colors -0,41 (0,01) 0,35 (0,01) -,60 (0,01) - % DAS 0,06 (0,49) 0,06 (0,49) 0,01 (0,95) 0,02 (0,82) - OR -0,13 (0,15) 0,03 (0,73) 0,01 (0,99) 0,05 (0,57) -0,05 (0,56) - NOR -0,14 (0,10) 0,38 (0,01) 0,38 (0,01) 0,17 (0,27) -0,17 (0,07) 0,20 (0,03) - IR -0,11 (0,23) 0,28 (0,04) 0,22 (0,02) 0,13 (0,15) -0,17 (0,07) 0,29 (0,01) 0,25 (0,01) - SSF -0,16 (0,10) 0,14 (0,13) 0,20 (0,04) 0,11 (0,25) -0,05 (0,61) 0,10 (0,27) 0,10 (0,28) 0,13 (0,16) - AUT -0,23 (0,01) -0,09 (0,35) 0,27 (0,01) 0,20 (0,01) -0,03 (0,75) -0,00 (0,94) -0,00 (0,98) -0,12 (0,20) -0,10 (0,29) - PPF -0,07 (0,46) 0,02 (0,78) 0,18 (0,05) 0,018 (0,05) 0,05 (0,54) -0,04 (0,64) -0,09 (0,33) -0,26 (0,01) 0,02 (0,79) 0,44 (0,00) - POS 0,02 (0,77) -0,07 (0,46) 0,04 (0,67) 0,09 (0,32) 0,09 (0,32) 0,11 (0,27) -0,10 (0,27) 0,05 (0,56) -0,11 (0,24) 0,17 (0,06) 0,30 (0,01) - D&D 0,02 (0,78) -0,03 (0,73) 0,00 (0,99) -0,08 (0,38) -0,10 (0,42) 0,04 (0,64) 0,07 (0,43) -0,03 (0,69) 0,17 (0,07) -0,02 (0,82) 0,10 (0,27) -0,00 (0,98) - INT -0,09 (0,35 -0,06 (0,53) 0,23 (0,01) 0,14 (0,13) -0,09 (0,35) -0,04 (0,66) 0,04 (0,68) -0,09 (0,32) -0,12 (0,21) 0,48 (0,00) 0,29 (0,02) 0,15 (0,12) 0,12 (0,22) - TMT-A -0,06 (0,52) -0,05 (0,61) 0,28 (0,04) 0,12 (0,20) -0,22 (0,02 ) -0,23 (0,22) 0,10 (0,28) 0,05 (0,59) 0,35 (0,00) 0,47 (0,00) 0,49 (0,00) 0,33 (0,01) 0,53 (0,00) 0,60 (0,00) - TMT-B 0,05 (0,58) -0,45 (0,00) -0,25 (0,00) -0,17 (0,08) 0,05 (0,58) 0,25 (0,00) -0,04 (0,63) -0,17 (0,68) -0,23 (0,01) 0,11 (0,23) 0,03 (0,71) 0,07 (0,47) 0,05 (0,57) 0,03 (0,73) 0,01 (0,88) - MMSE = Mini-Mental State Examination; VFT Animals = Verbal Fluency Test (animals category); VFT Colors = Verbal Fluency Test (colors category); % DAS = percentage of Death Anxiety Scale; OR = Organizational Religiosity; NOR = Non-Organizational Religiosity; IR = Intrinsic Religiosity; SSF = Social Support from Faith; AUT = Autonomy; PPF = Past, Present and Future Activities; POS = Positive Feelings; D&D = Death and Dying; INT = Intimacy; TMT-A = Trail Making Test Part A; TMT-B = Trail Making Test Part B DISCUSSION The aim of this study was to comprehensively examine the interrelationships between religiosity, quality of life, fear of death, and cognitive functioning, in order to provide a more integrated and nuanced understanding of how belief systems influence human experience. Results revealed that older adults exhibited high levels of religiosity, particularly in the organizational, non-organizational, and intrinsic dimensions, which were positively associated with cognitive performance, especially in verbal fluency tests and the MMSE. Quality of life was moderately high, with the highest scores observed in the domains of social participation and past, present, and future activities, while autonomy and intimacy had the lowest scores. Additionally, death anxiety showed a negative correlation with overall quality of life, suggesting that higher anxiety levels negatively impact well-being. Finally, advancing age was associated with poorer cognitive performance and reduced autonomy, indicating age-related functional decline. These results are particularly relevant in the context of aging societies, where existential concerns and well-being increasingly shape the health and care of older populations. The findings revealed weak but significant positive correlations between organizational and intrinsic religiosity and cognitive performance in older adults, with non-organizational religiosity specifically associated with better verbal fluency. These results align with prior studies suggesting that religious involvement (whether through structured activities, private practices, or internalized beliefs) may support cognitive health by promoting mental stimulation, routine, and social engagement. Religious involvement may benefit cognitive function through various mechanisms, including stress reduction, social support, and mental stimulation (George et al., 2002 ; Hosseini et al., 2022 ). Research also indicates that religiosity is linked to improved cognitive function in older adults with Alzheimer’s disease, as well as enhanced quality of life. For instance, organizational religiosity has been associated with better memory and language skills, while intrinsic religiosity relates to mental health outcomes, especially in men with higher education (Abdala et al., 2015 ; Kim et al., 2019 ). Moreover, among college students, greater non-organizational and intrinsic religiosity has been linked to reduced academic dishonesty, underscoring the broader cognitive and behavioral benefits of religious engagement (Storch & Storch, 2001 ). Religiosity was also modestly associated with certain domains of quality of life. For example, intrinsic religiosity correlated negatively with the "Past, Present, and Future Activities" domain, suggesting a possible tension between personal religious beliefs and engagement in life planning or continuity. Conversely, non-organizational religiosity was positively correlated with aspects such as sensory abilities, autonomy, intimacy, and overall quality of life. These findings support the notion that private spiritual practices may foster inner peace, resilience, and a sense of purpose, all of which are essential for subjective well-being in older age. Research suggests that spirituality plays a significant role in promoting well-being and resilience among older adults. Private spiritual practices and beliefs can enhance inner peace, coping capacity, and a sense of meaning, particularly among individuals with lower income and education levels (L. K. Manning, 2014 ; Vahia et al., 2011 ). Spirituality also functions as a means of navigating adversity through relationships, spiritual transformation, belief systems, and commitment to spiritual values (L. Manning et al., 2019 ). For many older adults, a relationship with a transcendent reality forms a central element of personal well-being, facilitating constructive coping with life’s challenges (Marcoen, 1994 ). However, the negative correlation between organizational religiosity and overall quality of life may indicate that participation in formal religious institutions does not always translate into perceived well-being, potentially due to mobility limitations, institutional disillusionment, or unmet spiritual needs. Death anxiety was moderately high among participants but showed a weak negative correlation with quality of life, suggesting that existential fear may subtly impact well-being in older adults. Despite high levels of religiosity, its association with death anxiety was minimal and not statistically significant, challenging the assumption that religiosity always acts as a protective factor. Research reveals a complex picture: while some studies find that religious beliefs can buffer against death anxiety (Bassett & Bussard, 2021 ), others report weak or no associations (French et al., 2017b ; Jong et al., 2018 ). This variability may depend on belief strength, views of God (punitive vs. forgiving), and personal adherence to religious values (Bassett & Bussard, 2021 ). Some evidence also suggests a curvilinear pattern, with the highest anxiety among those with uncertain beliefs and lower levels among the highly religious or non-religious (Jong et al., 2018 ). These findings highlight the need to consider individual, cultural, and multidimensional aspects when exploring the link between religiosity and death anxiety. As expected, age was negatively associated with cognitive performance, particularly in verbal fluency tasks, and with the autonomy domain of quality of life (Silva et al., 2011 ; Stephan et al., 2021 ; Stolwyk et al., 2015 ). These findings are consistent with literature on cognitive aging and the decline of executive functioning and language retrieval. Additionally, MMSE scores were negatively correlated with Trail Making Test times, reinforcing the link between general cognitive performance and attentional/executive functioning. Evidence shows that attention and executive processes, such as alerting, orienting, and cognitive control, are key to cognitive performance across the lifespan (Mackie et al., 2013 ). Cognitive reserve, shaped by factors like education and occupational complexity, also contributes to better performance in verbal fluency and attentional tasks (Roldán-Tapia et al., 2012 ). Moreover, the brain’s “rich club” organization supports integration of information across regions, facilitating attention and executive control (Baggio et al., 2015 ). These results highlight the importance of maintaining cognitive engagement and autonomy in aging, potentially through enriching religious or spiritual practices. This study was relevant for both clinical and community-based interventions aimed at promoting well-being in older adults. The findings suggest that religiosity (especially intrinsic and non-organizational forms) may serve as a protective factor for cognitive functioning and perceived quality of life, while also being associated with lower levels of death anxiety. This highlights the potential of integrating spiritual and religious dimensions into gerontological care, including psychological support and cognitive health programs. Health professionals could consider tailoring interventions that respect and engage individuals’ belief systems, fostering autonomy, intimacy, and social participation. Moreover, religious and community organizations may play a crucial role in supporting older adults by offering structured activities that enhance cognitive stimulation, emotional support, and existential meaning. Nevertheless, this study presents some limitations that should be acknowledged. Its cross-sectional design prevents causal inferences between religiosity, cognitive functioning, death anxiety, and quality of life. The sample was predominantly female and drawn from a specific geographic region using a non-probabilistic method, which limits the generalizability of the findings. The study also lacked control for potentially confounding clinical or psychological variables, such as depressive symptoms or social support. Furthermore, the cognitive assessment relied on screening tools that do not capture the full complexity of cognitive functioning, and although multiple dimensions of religiosity were assessed, deeper spiritual aspects were not explored. CONCLUSION In conclusion, religiosity, particularly in its intrinsic and non-organizational forms, showed a positive association with cognitive performance and certain domains of quality of life among older adults. Although death anxiety was moderately high, its relationship with religiosity was weak and not statistically significant, suggesting a more complex interplay than previously assumed. Advancing age was associated with declines in cognitive function and autonomy, reinforcing known patterns of cognitive aging. The findings underscore the potential role of private religious practices in promoting mental well-being and cognitive engagement in later life, though organizational religiosity was not consistently linked to enhanced quality of life. These results highlight the importance of integrating spiritual dimensions into aging-related interventions, while also acknowledging that religious involvement may not uniformly buffer against existential distress. Declarations Author Contribution J. M. S.: Conceptualization, Data curation, Formal Analysis, Investigation, Methodology, Visualization, Writing – Original Draft; E. M. A.: Data curation, Formal Analysis, Investigation, Methodology, Validation, Visualization, Writing – Original Draft; F. M. C.: Conceptualization, Investigation, Methodology, Writing – review and editing; H. J. C.-J.: Conceptualization, Methodology, Supervision, Writing – review and editing; H. O. C.: Data curation, Formal Analysis, Investigation, Methodology, Supervision; A. F. S.: Investigation, Supervision, Writing – review and editing; R. T.: Resources, Validation, Visualization, Writing – review and editing; S. S. A.: Formal Analysis, Project administration, Resources, Supervision, Writing – review and editing. DATA AVAILABILITY DECLARATION All data supporting the findings of this study are available within the paper and its Supplementary Information. DECLARATION OF INTEREST STATEMENT The authors declare that they have no conflicts of interest. 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Archives of Gerontology and Geriatrics , 97 , 104527. https://doi.org/10.1016/j.archger.2021.104527 Stolwyk, R., Bannirchelvam, B., Kraan, C., & Simpson, K. (2015). The cognitive abilities associated with verbal fluency task performance differ across fluency variants and age groups in healthy young and old adults. Journal of Clinical and Experimental Neuropsychology , 37 (1), 70–83. https://doi.org/10.1080/13803395.2014.988125 Storch, E. A., & Storch, J. B. (2001). Organizational, Nonorganizational, and Intrinsic Religiosity and Academic Dishonesty. Psychological Reports , 88 (2), 548–552. https://doi.org/10.2466/pr0.2001.88.2.548 Troyer, A. K., Moscovitch, M., & Winocur, G. (1997). Clustering and switching as two components of verbal fluency: evidence from younger and older healthy adults. Neuropsychology , 11 (1), 138–146. https://doi.org/10.1037//0894-4105.11.1.138 Vahia, I. V., Depp, C. A., Palmer, B. W., Fellows, I., Golshan, S., Thompson, W., Allison, M., & Jeste, D. V. (2011). Correlates of spirituality in older women. Aging & Mental Health , 15 (1), 97–102. https://doi.org/10.1080/13607863.2010.501069 Vishkin, A., Bigman, Y. E., Porat, R., Solak, N., Halperin, E., & Tamir, M. (2016). God rest our hearts: Religiosity and cognitive reappraisal. Emotion , 16 (2), 252–262. https://doi.org/10.1037/emo0000108 Walesa, C. (2020). Religijność jako rzeczywistość nieustannie tworzona i przetwarzająca. In Konteksty religijności i rodziny (pp. 15–60). Uniwersytet Papieski Jana Pawła II w Krakowie. https://doi.org/10.15633/9788374389327.02 Wen, Y. H. (2012). Religiosity and death anxiety of college students. The Journal of Human Resource and Adult Learning , 9 (2), 98. Additional Declarations No competing interests reported. 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It involves a personal relationship with God, manifested through religious awareness, feelings, decisions, community bonds, practices, morality, experiences, and faith profession (Walesa, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Religiosity levels can be influenced by adversity, insecurity, or increased religious organizations (Bentzen, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). It impacts various socioeconomic outcomes, including traditional values, education, science, democracy, income, health, crime rates, and well-being (Bentzen, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eReligiosity, rooted in personal beliefs, can lead to complex behavioral adaptations and influence how individuals affect the emotions and perceptions of others. It shapes not only internal experiences but also interpersonal dynamics. For example, research exploring the relationship between religiosity and fear of death, as well as its impact on cognitive processes, has produced mixed findings (Florian \u0026amp; Mikulincer, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e1993\u003c/span\u003e). These variations suggest that the influence of religiosity is nuanced and may depend on factors such as cultural context, individual belief systems, and the specific dimensions of religiosity being examined. Some studies found that religious individuals reported lower levels of death anxiety compared to non-religious counterparts (Florian \u0026amp; Mikulincer, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e1993\u003c/span\u003e). However, other research indicated no significant connection between religiosity and fear of death (D\u0026eacute;muthov\u0026aacute;, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Factors such as cognitive and emotional susceptibility to mortality cues, as well as gender, were found to be stronger predictors of death anxiety than religiosity (French et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2017a\u003c/span\u003e). For cancer patients, religiosity and time perspective played adaptive roles in coping with death fear and improving quality of life (Frolova, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Age was also identified as a more important factor than religiosity in relation to fear of death (D\u0026eacute;muthov\u0026aacute;, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eResearch on the relationship between religiosity and death anxiety has yielded mixed results. Some studies found a negative correlation, with higher religiosity associated with lower death anxiety (Al-Sabwah \u0026amp; Abdel-Khalek, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Hui \u0026amp; Coleman, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). However, others revealed a curvilinear relationship, where individuals with moderate religiosity exhibited higher death anxiety compared to those with low or high religiosity (Downey, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e1984\u003c/span\u003e; Wen, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Factors influencing this relationship include age, gender, and specific aspects of religiosity. Intrinsic religiosity was found to reduce death anxiety by fostering more positive afterlife beliefs and greater ego integrity in older adults (Hui \u0026amp; Coleman, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Gender differences were observed, with females showing more fear of pain related to death (Wen, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). The relationship between religiosity and death anxiety may also be affected by situational variables and personal experiences with death (Al-Sabwah \u0026amp; Abdel-Khalek, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Hui \u0026amp; Coleman, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eResearch indicates a generally positive relationship between religiosity and quality of life (QoL). Multiple studies found that higher religiosity correlates with improved QoL in various populations, including breast cancer patients (Dewi et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) and elderly adults (Chaves et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Religiosity often serves as a coping mechanism in adverse situations (Melo et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). However, the relationship is complex and context dependent. In dyads of individuals with dementia (IWDs) and their caregivers, caregivers' religiosity positively influenced IWDs' self-reported QoL, while IWDs' religiosity negatively affected caregivers' perceptions of IWDs' QoL (Nagpal et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Some studies reported no association between religiosity and QoL(Dewi et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eResearch indicates that religiosity can also positively influence cognitive factors across different populations. Kim et al. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) found that in patients with Alzheimer's disease, organizational and non-organizational religious activities were associated with improved memory and constructional abilities. Similarly, Egierd et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) reported that among older Chinese adults in Chicago, participation in organized religion predicted higher global cognitive function, particularly in working memory. In contrast, home religious practices showed no significant relationship with cognitive measures. Additionally, Vishkin et al. \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) demonstrated that higher religiosity is linked to more effective use of cognitive reappraisal, an emotion regulation strategy, across various religious groups.\u003c/p\u003e\u003cp\u003eDespite growing interest in the psychological and social implications of religiosity, there remains a significant gap in understanding how it simultaneously interacts with quality of life, fear of death, and cognitive functioning in a holistic view. Existing studies have often examined these variables in isolation or within narrowly defined populations, leading to fragmented and sometimes contradictory findings. Moreover, few studies have attempted to integrate these constructs into a comprehensive framework that considers their dynamic interrelationships. Given the potential of religiosity to serve as both a coping mechanism and a cognitive schema, it is critical to explore how it may buffer existential fears, enhance perceived well-being, and influence cognitive processes such as perception, memory, and decision-making. This study aims to bridge this gap by examining these relationships holistically, providing a more nuanced understanding of how belief systems shape human experience. Such insights are particularly relevant in multicultural and aging societies, where existential concerns and quality of life are increasingly prominent.\u003c/p\u003e"},{"header":"MATERIALS \u0026 METHODS","content":"\u003cp\u003eThis study was approved by the Human Research Ethics Committee of the \u003cem\u003eXXX\u003c/em\u003e, under protocol number 6.430.170. All procedures were conducted in accordance with the Declaration of Helsinki (466/2012). Prior to participation, all individuals received detailed information about the study and signed an informed consent form.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003eThis was an analytical cross-sectional study aimed at investigating the relationship between cognitive ability, fear of death, and religiosity with quality of life in community-dwelling older adults. The application of the tests to the participants selected as the sample occurred sequentially over two days. Cognitive ability was assessed using the Mini-Mental State Examination (MMSE), Verbal Fluency Test (VFT), and Trail Making Test (TMT); fear of death was evaluated using the Death Anxiety Questionnaire; religiosity was measured using the Duke University Religion Index; and quality of life was assessed using the World Health Organization Quality of Life Questionnaire for Older Adults (WHOQOL-OLD).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eThe sample consisted of older adults of both sexes attending the \u003cem\u003eXXX\u003c/em\u003e. A convenience sampling procedure was adopted. Considering the population attending the center, a total of 114 older adults were identified, of whom 105 agreed to participate via direct contact and met the inclusion criteria of the study. The inclusion criteria were: (i) age 60 years or older; (ii) being community-dwelling; and (iii) having the minimum physical and cognitive abilities to participate in the interventions, such as being able to walk, sit and stand, hear commands, and respond verbally. Exclusion criteria included: (i) acute myocardial infarction or unstable angina within the past year; (ii) severe and uncontrolled systemic arterial hypertension; (iii) pneumothorax; (iv) pleurocutaneous or pulmonary fistulas; and (v) recent surgery or trauma involving the upper airways, chest, or abdomen.\u003c/p\u003e\n\u003ch3\u003eGeneral Procedures\u003c/h3\u003e\n\u003cp\u003eDuring the data collection period, the older adults were assessed through a sequence of tests that examined the following variables: anamnesis, cognitive capacity, religiosity, fear of death, and quality of life. The selected participants were assessed in the morning, from 8:00 a.m. to 11:00 a.m., over two consecutive days. On the first day, a structured anamnesis was conducted, collecting sociodemographic and clinical information such as name, age, sex, race, marital status, occupation, educational level, comorbidities, and current medication use, and cognitive function was analyzed using three tests: the MMSE, VFT, and TMT. On the second day, the Duke University Religion Index, the Death Anxiety Questionnaire and the WHOQOL-OLD questionnaire were applied.\u003c/p\u003e\n\u003ch3\u003eCognitive Function\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eMini-Mental State Examination (MMSE)\u003c/h2\u003e\u003cp\u003eThe MMSE evaluates orientation, registration and short-term memory, attention, concentration, language (naming, sentence writing, and comprehension), and visuospatial skills. Individual items are summed to generate a total score, ranging from 0 to 30. Higher scores indicate greater global cognitive ability (D. M. de Melo \u0026amp; Barbosa, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). The test was divided into two parts. The first part assessed orientation, memory, and attention, with a maximum score of 21 points. The second part focused on specific skills such as naming and comprehension, with a maximum of 9 points. For evaluation purposes, the total score obtained by each participant was considered. Scores above 25 were interpreted as normal. Scores between 21 and 24 indicated suspected mild cognitive impairment; scores between 10 and 20, moderate impairment; and scores of 9 or below, severe impairment (Brucki et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2003\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eVerbal Fluency Test (VFT)\u003c/h2\u003e\u003cp\u003eOlder adults were assessed using two semantic verbal fluency tests (animal and color categories). First, in the animal category fluency task, participants were asked to name as many animals as possible within one minute. In the color category fluency task, participants were asked to list as many colors as they could, also within a one-minute time limit (Troyer et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e1997\u003c/span\u003e). One point was assigned for each unique animal or color named. Incorrect or repeated responses were not considered. The number of distinct items named during the task period represented the score for both test categories.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eTrail Making Test (TMT)\u003c/h3\u003e\n\u003cp\u003eThe Trail Making Test evaluates visual attention, mental flexibility, and executive functioning. The test is divided into two parts: TMT-A: requires the participant to draw a line connecting numbers in ascending order (1\u0026ndash;25); TMT-B: requires alternating between numbers and letters in sequence (1-A-2-B-3-C...). The participant\u0026rsquo;s performance is measured by the time taken to complete each task, with a time limit of 300 seconds for each part. Longer completion times indicate lower executive functioning (Mota et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eReligiosity\u003c/h3\u003e\n\u003cp\u003eReligiosity was assessed using the Duke University Religion Index (DUREL), which evaluates three dimensions of religious involvement: Organizational Religious Activity (OR): frequency of attending religious services; Non-Organizational Religious Activity (NOR): frequency of private religious activities such as prayer and meditation and; Intrinsic Religiosity (IR): degree of personal religious commitment or motivation. The instrument consists of five items \u0026mdash;one for OR, one for NOR, and three for IR\u0026mdash; scored on a Likert-type scale. Higher scores reflect greater levels of religiosity (Moreira-Almeida et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eFear of Death\u003c/h2\u003e\u003cp\u003eThe fear of death was measured using the Death Anxiety Questionnaire developed by Neimeyer and Moore (1994). The instrument consists of 26 items that assess attitudes, beliefs, and fears related to death, rated on a five-point Likert scale ranging from 1 (\"strongly disagree\") to 5 (\"strongly agree\"). The final score is the sum of the points from each item, with higher scores indicating higher levels of death anxiety (Neimeyer, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e1994\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eQuality of Life\u003c/h2\u003e\u003cp\u003eQuality of life was assessed using the World Health Organization Quality of Life for Older Adults questionnaire (WHOQOL-OLD), adapted for the Brazilian population. This instrument comprises 24 items that evaluate different aspects of the lives of older adults, including sensory abilities, autonomy, satisfaction with past, present, and future activities, social participation, perceptions regarding death and dying, and intimacy. Each item is rated on a five-point Likert scale ranging from 1 to 5. The final score is calculated by averaging the scores of the different facets, with higher scores indicating a better perception of quality of life (Fleck et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2003\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eData analysis was conducted using SPSS software version 26.0, employing both descriptive and inferential statistical approaches. Frequency and percentage were used as descriptive measures for categorical variables. For numerical variables, data normality was initially assessed using the Shapiro-Wilk test. Since the data did not follow a normal distribution, the results were described using the median and interquartile range (Q1; Q3). Correlation analyses were performed to examine potential relationships between variables, employing Spearman\u0026rsquo;s correlation coefficient (Akoglu, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). A significance level of 5% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) was adopted.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe sociodemographic characteristics of the older adults are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Among all participants, the majority were female (84.7%), of mixed race (47.6%), had more than eight years of education (39.0%), and reported a diagnosis of systemic arterial hypertension (61.9%). The most frequently reported religious affiliations were Catholic (75.2%), Evangelical (13.3%), and Pentecostal (5.7%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of sociodemographic and religious variables among older adults.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e84.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMixed race (Pardo)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e47.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlack\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndigenous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation Level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0 to 3 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4 to 8 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMore than 8 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiagnosed Conditions\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension (SAH)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e61.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes Mellitus (DM)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReligious Affiliation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCatholic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEvangelical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePentecostal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdventist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJehovah\u0026rsquo;s Witness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpiritism (Kardecist)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo affiliation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eSAH\u0026thinsp;=\u0026thinsp;Systemic Arterial Hypertension; DM\u0026thinsp;=\u0026thinsp;Diabetes Mellitus\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe cognitive performance of the older adults in the present study is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The results showed that the average score on the MMSE was 23.2. The mean number of animals named in the verbal fluency test was 9.6, and the mean number of colors was 8.2. In the Trail Making Test A, participants took an average of 52.6 seconds to complete the task, while in Trail Making Test B, the average completion time was 59.3 seconds.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCognitive performance of older adults.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQ1\u0026ndash;Q3\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMMSE (points)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22.0\u0026ndash;26.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVerbal Fluency \u0026ndash; Animals (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.0\u0026ndash;12.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVerbal Fluency \u0026ndash; Colors (n)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.5\u0026ndash;10.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrail Making Test A (sec)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e47.5\u0026ndash;60.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrail Making Test B (sec)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e60.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60.0\u0026ndash;60.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eMMSE\u0026thinsp;=\u0026thinsp;Mini-Mental State Examination; TFV\u0026thinsp;=\u0026thinsp;Verbal Fluency Test; TMT\u0026thinsp;=\u0026thinsp;Trail Making Test.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the medians and interquartile ranges (Q1\u0026ndash;Q3) of religiosity, death anxiety, and quality of life among the participants in the present study. The older adults exhibited high levels of organizational religiosity (mean: 4.8), non-organizational religiosity (mean: 4.7), and intrinsic religiosity (mean: 12.9). Additionally, the participants demonstrated moderate levels of death anxiety (mean: 55.5). Regarding quality of life, the domains with the lowest scores were intimacy (mean: 67.4) and autonomy (mean: 67.7), while the highest scores were observed in social participation (mean: 78.8).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eReligiosity, death anxiety, and quality of life among older adults.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eQ1\u0026ndash;Q3\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReligiosity\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOrganizational (OR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.0\u0026ndash;6.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-organizational (NOR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.0\u0026ndash;5.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntrinsic (IR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.0\u0026ndash;15.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDeath Anxiety\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal DAS Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e41.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38.0\u0026ndash;45.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDAS (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e54.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e50.7\u0026ndash;60.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eQuality of Life (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSensory Abilities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e75.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e65.0\u0026ndash;90.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAutonomy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60.0\u0026ndash;75.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePast, Present, and Future Activities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e80.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e72.5\u0026ndash;80.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial Participation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e80.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e75.0\u0026ndash;85.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeath and Dying\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e75.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60.0\u0026ndash;87.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntimacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e70.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e55.0\u0026ndash;80.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall Quality of Life\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e74.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e69.1\u0026ndash;78.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOR\u0026thinsp;=\u0026thinsp;Organizational Religiosity; NOR\u0026thinsp;=\u0026thinsp;Non-Organizational Religiosity; IR\u0026thinsp;=\u0026thinsp;Intrinsic Religiosity; DAS\u0026thinsp;=\u0026thinsp;Death Anxiety Scale.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the Spearman correlation matrix for the variables under investigation. Weak, negative, and statistically significant correlations were observed between age and the verbal fluency test (animals) (r = -0.33; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), the verbal fluency test (colors) (r = -0.41; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and the autonomy domain of the WHOQOL-OLD (r = -0.23; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Weak, positive, and significant correlations were found between the MMSE and verbal fluency (animals) (r\u0026thinsp;=\u0026thinsp;0.27; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), verbal fluency (colors) (r\u0026thinsp;=\u0026thinsp;0.35; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), organizational religiosity (OR) (r\u0026thinsp;=\u0026thinsp;0.38; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and intrinsic religiosity (IR) (r\u0026thinsp;=\u0026thinsp;0.28; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, weak, negative, and significant correlations were observed between the MMSE and Trail Making Test A (r = -0.45; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and B (r = -0.34; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The verbal fluency test (animals) showed a weak, positive, and significant correlation with non-organizational religiosity (NOR) (r\u0026thinsp;=\u0026thinsp;0.38; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), intrinsic religiosity (IR) (r\u0026thinsp;=\u0026thinsp;0.22; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), the sensory abilities domain (r\u0026thinsp;=\u0026thinsp;0.20; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), autonomy (r\u0026thinsp;=\u0026thinsp;0.27; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), intimacy (r\u0026thinsp;=\u0026thinsp;0.23; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and overall quality of life (r\u0026thinsp;=\u0026thinsp;0.28; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) from the WHOQOL-OLD. Negative correlations were found with Trail Making Test A (r = -0.25; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and B (r = -0.25; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The verbal fluency test (colors) showed weak, positive, and significant correlations with autonomy (r\u0026thinsp;=\u0026thinsp;0.20; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and absolute power (r\u0026thinsp;=\u0026thinsp;0.19; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), as well as a weak, negative correlation with Trail Making Test B (r = -0.23; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eFurthermore, death anxiety showed a weak, negative, and significant correlation with overall quality of life (r = -0.22; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) on the WHOQOL-OLD. Organizational religiosity (OR) had a weak, positive, and significant correlation with Trail Making Test A (r\u0026thinsp;=\u0026thinsp;0.25; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and a negative correlation with overall quality of life (r = -0.23; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Intrinsic religiosity (IR) showed a weak, negative, and significant correlation with the past, present, and future activities domain of the WHOQOL-OLD (r = -0.26; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The sensory abilities domain of the WHOQOL-OLD was weakly, negatively, and significantly correlated with Trail Making Test A (r = -0.23; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Social participation showed a positive correlation with Trail Making Test B (r\u0026thinsp;=\u0026thinsp;0.30; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and a negative correlation with the clock-drawing test (r = -0.24; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, overall quality of life was weakly, positively, and significantly correlated with absolute power (r = -0.20; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eReligiosity, death anxiety, and quality of life in older adults.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"17\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" 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colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSSF\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0,16 (0,10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0,14 (0,13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0,20 (0,04)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0,11 (0,25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-0,05 (0,61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0,10 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colname=\"c9\"\u003e\u003cp\u003e0,05 (0,56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-0,11 (0,24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0,17 (0,06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e\u003cb\u003e0,30 (0,01)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eD\u0026amp;D\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0,02 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(0,00)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTMT-B\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0,05 (0,58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e-0,45 (0,00)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e-0,25 (0,00)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0,17 (0,08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0,05 (0,58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003e0,25 (0,00)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-0,04 (0,63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0,17 (0,68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e-0,23 (0,01)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e0,11 (0,23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e0,03 (0,71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e0,07 (0,47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e0,05 (0,57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e0,03 (0,73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e0,01 (0,88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c17\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"17\"\u003eMMSE\u0026thinsp;=\u0026thinsp;Mini-Mental State Examination; VFT Animals\u0026thinsp;=\u0026thinsp;Verbal Fluency Test (animals category); VFT Colors\u0026thinsp;=\u0026thinsp;Verbal Fluency Test (colors category); % DAS\u0026thinsp;=\u0026thinsp;percentage of Death Anxiety Scale; OR\u0026thinsp;=\u0026thinsp;Organizational Religiosity; NOR\u0026thinsp;=\u0026thinsp;Non-Organizational Religiosity; IR\u0026thinsp;=\u0026thinsp;Intrinsic Religiosity; SSF\u0026thinsp;=\u0026thinsp;Social Support from Faith; AUT\u0026thinsp;=\u0026thinsp;Autonomy; PPF\u0026thinsp;=\u0026thinsp;Past, Present and Future Activities; POS\u0026thinsp;=\u0026thinsp;Positive Feelings; D\u0026amp;D\u0026thinsp;=\u0026thinsp;Death and Dying; INT\u0026thinsp;=\u0026thinsp;Intimacy; TMT-A\u0026thinsp;=\u0026thinsp;Trail Making Test Part A; TMT-B\u0026thinsp;=\u0026thinsp;Trail Making Test Part B\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe aim of this study was to comprehensively examine the interrelationships between religiosity, quality of life, fear of death, and cognitive functioning, in order to provide a more integrated and nuanced understanding of how belief systems influence human experience. Results revealed that older adults exhibited high levels of religiosity, particularly in the organizational, non-organizational, and intrinsic dimensions, which were positively associated with cognitive performance, especially in verbal fluency tests and the MMSE. Quality of life was moderately high, with the highest scores observed in the domains of social participation and past, present, and future activities, while autonomy and intimacy had the lowest scores. Additionally, death anxiety showed a negative correlation with overall quality of life, suggesting that higher anxiety levels negatively impact well-being. Finally, advancing age was associated with poorer cognitive performance and reduced autonomy, indicating age-related functional decline. These results are particularly relevant in the context of aging societies, where existential concerns and well-being increasingly shape the health and care of older populations.\u003c/p\u003e\u003cp\u003eThe findings revealed weak but significant positive correlations between organizational and intrinsic religiosity and cognitive performance in older adults, with non-organizational religiosity specifically associated with better verbal fluency. These results align with prior studies suggesting that religious involvement (whether through structured activities, private practices, or internalized beliefs) may support cognitive health by promoting mental stimulation, routine, and social engagement. Religious involvement may benefit cognitive function through various mechanisms, including stress reduction, social support, and mental stimulation (George et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Hosseini et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Research also indicates that religiosity is linked to improved cognitive function in older adults with Alzheimer\u0026rsquo;s disease, as well as enhanced quality of life. For instance, organizational religiosity has been associated with better memory and language skills, while intrinsic religiosity relates to mental health outcomes, especially in men with higher education (Abdala et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Kim et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Moreover, among college students, greater non-organizational and intrinsic religiosity has been linked to reduced academic dishonesty, underscoring the broader cognitive and behavioral benefits of religious engagement (Storch \u0026amp; Storch, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2001\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eReligiosity was also modestly associated with certain domains of quality of life. For example, intrinsic religiosity correlated negatively with the \"Past, Present, and Future Activities\" domain, suggesting a possible tension between personal religious beliefs and engagement in life planning or continuity. Conversely, non-organizational religiosity was positively correlated with aspects such as sensory abilities, autonomy, intimacy, and overall quality of life. These findings support the notion that private spiritual practices may foster inner peace, resilience, and a sense of purpose, all of which are essential for subjective well-being in older age. Research suggests that spirituality plays a significant role in promoting well-being and resilience among older adults. Private spiritual practices and beliefs can enhance inner peace, coping capacity, and a sense of meaning, particularly among individuals with lower income and education levels (L. K. Manning, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Vahia et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Spirituality also functions as a means of navigating adversity through relationships, spiritual transformation, belief systems, and commitment to spiritual values (L. Manning et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). For many older adults, a relationship with a transcendent reality forms a central element of personal well-being, facilitating constructive coping with life\u0026rsquo;s challenges (Marcoen, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e1994\u003c/span\u003e). However, the negative correlation between organizational religiosity and overall quality of life may indicate that participation in formal religious institutions does not always translate into perceived well-being, potentially due to mobility limitations, institutional disillusionment, or unmet spiritual needs.\u003c/p\u003e\u003cp\u003eDeath anxiety was moderately high among participants but showed a weak negative correlation with quality of life, suggesting that existential fear may subtly impact well-being in older adults. Despite high levels of religiosity, its association with death anxiety was minimal and not statistically significant, challenging the assumption that religiosity always acts as a protective factor. Research reveals a complex picture: while some studies find that religious beliefs can buffer against death anxiety (Bassett \u0026amp; Bussard, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), others report weak or no associations (French et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2017b\u003c/span\u003e; Jong et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). This variability may depend on belief strength, views of God (punitive vs. forgiving), and personal adherence to religious values (Bassett \u0026amp; Bussard, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Some evidence also suggests a curvilinear pattern, with the highest anxiety among those with uncertain beliefs and lower levels among the highly religious or non-religious (Jong et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). These findings highlight the need to consider individual, cultural, and multidimensional aspects when exploring the link between religiosity and death anxiety.\u003c/p\u003e\u003cp\u003eAs expected, age was negatively associated with cognitive performance, particularly in verbal fluency tasks, and with the autonomy domain of quality of life (Silva et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2011\u003c/span\u003e; Stephan et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Stolwyk et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). These findings are consistent with literature on cognitive aging and the decline of executive functioning and language retrieval. Additionally, MMSE scores were negatively correlated with Trail Making Test times, reinforcing the link between general cognitive performance and attentional/executive functioning. Evidence shows that attention and executive processes, such as alerting, orienting, and cognitive control, are key to cognitive performance across the lifespan (Mackie et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Cognitive reserve, shaped by factors like education and occupational complexity, also contributes to better performance in verbal fluency and attentional tasks (Rold\u0026aacute;n-Tapia et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). Moreover, the brain\u0026rsquo;s \u0026ldquo;rich club\u0026rdquo; organization supports integration of information across regions, facilitating attention and executive control (Baggio et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). These results highlight the importance of maintaining cognitive engagement and autonomy in aging, potentially through enriching religious or spiritual practices.\u003c/p\u003e\u003cp\u003eThis study was relevant for both clinical and community-based interventions aimed at promoting well-being in older adults. The findings suggest that religiosity (especially intrinsic and non-organizational forms) may serve as a protective factor for cognitive functioning and perceived quality of life, while also being associated with lower levels of death anxiety. This highlights the potential of integrating spiritual and religious dimensions into gerontological care, including psychological support and cognitive health programs. Health professionals could consider tailoring interventions that respect and engage individuals\u0026rsquo; belief systems, fostering autonomy, intimacy, and social participation. Moreover, religious and community organizations may play a crucial role in supporting older adults by offering structured activities that enhance cognitive stimulation, emotional support, and existential meaning.\u003c/p\u003e\u003cp\u003eNevertheless, this study presents some limitations that should be acknowledged. Its cross-sectional design prevents causal inferences between religiosity, cognitive functioning, death anxiety, and quality of life. The sample was predominantly female and drawn from a specific geographic region using a non-probabilistic method, which limits the generalizability of the findings. The study also lacked control for potentially confounding clinical or psychological variables, such as depressive symptoms or social support. Furthermore, the cognitive assessment relied on screening tools that do not capture the full complexity of cognitive functioning, and although multiple dimensions of religiosity were assessed, deeper spiritual aspects were not explored.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn conclusion, religiosity, particularly in its intrinsic and non-organizational forms, showed a positive association with cognitive performance and certain domains of quality of life among older adults. Although death anxiety was moderately high, its relationship with religiosity was weak and not statistically significant, suggesting a more complex interplay than previously assumed. Advancing age was associated with declines in cognitive function and autonomy, reinforcing known patterns of cognitive aging. The findings underscore the potential role of private religious practices in promoting mental well-being and cognitive engagement in later life, though organizational religiosity was not consistently linked to enhanced quality of life. These results highlight the importance of integrating spiritual dimensions into aging-related interventions, while also acknowledging that religious involvement may not uniformly buffer against existential distress.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJ. M. S.: Conceptualization, Data curation, Formal Analysis, Investigation, Methodology, Visualization, Writing \u0026ndash; Original Draft; E. M. A.: Data curation, Formal Analysis, Investigation, Methodology, Validation, Visualization, Writing \u0026ndash; Original Draft; F. M. C.: Conceptualization, Investigation, Methodology, Writing \u0026ndash; review and editing; H. J. C.-J.: Conceptualization, Methodology, Supervision, Writing \u0026ndash; review and editing; H. O. C.: Data curation, Formal Analysis, Investigation, Methodology, Supervision; A. F. S.: Investigation, Supervision, Writing \u0026ndash; review and editing; R. T.: Resources, Validation, Visualization, Writing \u0026ndash; review and editing; S. S. A.: Formal Analysis, Project administration, Resources, Supervision, Writing \u0026ndash; review and editing.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDATA AVAILABILITY DECLARATION\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;All data supporting the findings of this study are available within the paper and its Supplementary Information. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDECLARATION OF INTEREST STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFUNDING SOURCES\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbdala, G. A., Kimura, M., Duarte, Y. 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Religiosity and death anxiety of college students. \u003cem\u003eThe Journal of Human Resource and Adult Learning\u003c/em\u003e, \u003cem\u003e9\u003c/em\u003e(2), 98.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Religiosity, Cognitive Function, Quality of Life, Death Anxiety, Older Adults","lastPublishedDoi":"10.21203/rs.3.rs-6888781/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6888781/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and Objectives:\u003c/strong\u003e Religiosity has been associated with various psychosocial outcomes in older adults, including cognitive function, quality of life (QoL), and attitudes toward death. However, the interplay among these variables remains underexplored. This study aimed to examine the relationships between religiosity, cognitive performance, fear of death, and QoL in community-dwelling older adults.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e An analytical cross-sectional study was conducted with 105 older adults from a senior community center in Cuiabá, Brazil. Cognitive function was assessed using the Mini-Mental State Examination, Verbal Fluency Test, and Trail Making Test. Religiosity was measured via the Duke University Religion Index, fear of death using the Death Anxiety Questionnaire, and QoL with the WHOQOL-OLD. Spearman’s correlations evaluated associations among variables.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Participants demonstrated high religiosity and moderate death anxiety. Weak, positive correlations were observed between intrinsic religiosity and MMSE (r=0.28, p=0.04) and verbal fluency (r=0.22, p=0.02). Non-organizational religiosity was positively associated with verbal fluency (r=0.38, p=0.01) and overall QoL (r=0.20, p=0.03). Death anxiety showed a weak, negative correlation with QoL (r=-0.22, p=0.02). Advancing age was associated with poorer cognitive performance in verbal fluency (animals: r=-0.33, p=0.01; colors: r=-0.41, p=0.01) and reduced autonomy (r=-0.23, p=0.01).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion and Implications:\u003c/strong\u003e Findings suggest that private and intrinsic religious engagement may support cognitive health and aspects of QoL in older adults, while organizational religiosity did not consistently correlate with well-being. The minimal association between religiosity and death anxiety challenges assumptions of a protective effect. These results underscore the value of integrating individualized spiritual considerations into gerontological interventions.\u003c/p\u003e","manuscriptTitle":"Relationship between cognitive factors, religiosity, fear of death and quality of life in community older adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-13 11:11:35","doi":"10.21203/rs.3.rs-6888781/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5991eb87-40cd-4309-a4a3-8972f5449eac","owner":[],"postedDate":"October 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T01:55:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-13 11:11:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6888781","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6888781","identity":"rs-6888781","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}