Examining the Association between Functional Social Support, Marital Status, and Memory in Middle-Aged and Older Adults in Canada: A Mixed Methods Study

Abstract

Although several studies have found that functional social support (FSS) promotes memory through stress-buffering mechanisms, the role of marital status in shaping this association remains underexplored. This thesis – a sequential explanatory mixed-methods study – is the first research to examine whether marital status modifies the association between FSS and memory in community-dwelling, middle-aged and older adults (45-85 years old). Data for the quantitative portion of the study were obtained from the Tracking Cohort of the Canadian Longitudinal Study on Aging (CLSA). Memory was regressed on FSS, adjusting for various sociodemographic, lifestyle, and health-related covariates, in a linear mixed effects model. The moderating effect of marital status was assessed by adding its interaction with FSS to the model. Results showed significant and positive adjusted associations for overall FSS (β: 0.07; 95% CI: 0.01, 0.13) and two FSS subtypes, namely positive interactions (β: 0.06; 95% CI: 0.01, 0.11) and affectionate support (β: 0.05; 95% CI: 0.00, 0.11), with memory. However, the interaction between marital status and FSS (overall and subtypes) was not statistically significant (likelihood ratio test p-value = 0.75), indicating that FSS did not have differing effects on memory according to marital status. Two sensitivity analyses – one stratifying the sample by baseline marital status and another comparing different missing data approaches – confirmed the initial findings. For the qualitative portion, semi-structured interviews were conducted with a sample of 18 community-dwelling adults who resembled the CLSA population and reported different categories of marital status. Each interview was audio recorded, transcribed verbatim, and thematically analyzed with the goal of explaining and contextualizing the quantitative results. Three major themes emerged from the interviews to help explain why marital status, contrary to a priori expectations, did not impact the FSS-memory association: “learning to cope” – participants used other alternatives besides a spouse to deal with memory challenges; “context matters” – contextual factors such as marital quality may affect this association; and, “doing more harm than good” – some spouses may provide too much support, reducing participants’ autonomy to stimulate their own cognitive processes. The thesis findings highlight the complexity of marital relationships and emphasize the need to consider factors such as satisfaction with one’s marital status and adequacy of support to provide a comprehensive understanding of how social and marital dynamics impact cognitive trajectories. This research suggests public health initiatives focused on enhancing social support could promote cognitive health in aging populations, regardless of marital status.