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. 2025 Sep 26;25:729. doi: 10.1186/s12877-025-06375-w

Trust and cognitive function: a population-based cross-sectional survey among older adults relocated for poverty alleviation in Shanxi, China

Le Yang 1,✉, Jing Wang 1, Dan Guo 1, Xin Zhang 1, Ling Wang 1
PMCID: PMC12465411  PMID: 41013376

Abstract

Objective

This study investigated the association between generalized/particularized trust and cognitive function, with a focus on sex differences, among Chinese older adults relocated for poverty alleviation.

Methods

In 2023, a total of 1882 relocated older adults (≥ 60) were surveyed by using a multi-stage stratified sampling method in Shanxi province, China, under a cross-sectional study design. Trust was assessed in generalized trust (i.e. generalized trust in society and in community) and particularized trust (i.e. particularized trust in family, friends, neighbours, and authoritative identity). Older adults’ cognitive function was measured by the Chinese version of Mini-Mental State Examination (CMMSE). Hierarchical linear regression was performed to determine the association between trust and cognitive function.

Results

Particularized trust in friends and particularized trust in authoritative identity were positively associated with cognitive function in the full sample. After controlling all confounders (i.e. demographic and socioeconomic characteristics, health behaviors and health status, and relocation characteristics), older adults who trusted in friends (β = 0.08, 95% CI: 0.23;1.94, P < 0.05) and who trusted in community/village staff (β = 0.08, 95% CI: 0.26;1.69, P < 0.01) reported better cognitive function. Generalized trust in society was negatively associated with cognitive function, older men who trusted most people showed lower cognitive function (β=-0.14, 95%CI: -2.67;-0.82, P < 0.001), and the comparison of the regression coefficients between the male and female were significantly different using suest test (P < 0.01). Particularized trust in friends and authoritative identity was positively associated with the cognitive function of relocated older men. However, the association between trust and cognitive function was not found among relocated older women.

Conclusions

Trust is associated with the cognitive function of older adults relocated for poverty alleviation in China, future policy interventions must highlight relocated older adults who have low trust in friends and community/village staff, more attention needs to be paid to the tailored interventions of trust promotion to different sexes.

Keywords: Relocation for poverty alleviation, Cognitive function, Trust, Older adults, China

Introduction

With the aging population increasing rapidly, there is a growing need for policies and interventions to address health problems posed by aging [1]. As an important indicator of older adults’ health, cognitive function will decline associated with aging, greatly affecting their quality of life and well-being [2, 3]. Moreover, cognitive decline is positively associated with dementia, which cannot be cured [4]. Therefore, it is of great significance to identify the critical influencing factors of cognitive function and their mechanism for formulating corresponding public health policies and interventions to reduce the social and economic burden of diseases caused by the cognitive decline of older adults.

Many studies have found that age, education, income, physical inactivity, healthy behaviours, and chronic diseases can contribute to the cognitive function of older adults [5–7]. Cognitive function would be influenced by various changes, such as socioeconomic resources, environmental factors, and lifestyles [8]. Sex differences in cognitive function among older adults have always been a topic of academic discussion, a study found that among older Japanese people dwelling in rural areas, women’s Mini-Mental State Examination (MMSE) scores were significantly higher than men [9], but in another study, among 677 rural adults aged 55–65 years, men’s MMSE scores (Mean:27, P25:24, P75:28) was higher than women (Mean:23, P25:17, P75:26) [10]. In recent years, the association between social capital and cognitive function has been studied globally, and previous research presented the important role of social capital in influencing cognitive function [11, 12]. Social capital could protect the cognitive function of older adults through intellectual stimulation, instrumental and emotional support, health-beneficial behaviors promotion, and health-related information diffusion [13]. For the concept of social capital, there is still a debate, Putnam defined social capital as features of social organization such as networks, norms, and social trust that facilitate coordination and cooperation for mutual benefit [14], Bourdieu defined social capital as the aggregate of the actual or potential resources which are linked to possession of a durable network of more or less institutionalized relationships of mutual acquaintance and recognition [15], and Kawachi and Berkman defined social capital as the resources that are accessed by individuals as a result of their membership of a network or a group [16]. In health research, social capital has been commonly studied and discussed as structural (e.g. social participation, social networks) [4, 17] and cognitive social capital (e.g. trust) [18, 19] for their different relationships with health outcomes [20]. Public health research commonly adopts the concept of social capital from a theoretical framework that considers trust to be a core element [21].

Trust, a fundamental concept of interpersonal relationships, refers to certain expectations that trustors develop and have for the trustees and their behaviors [22]. Generally, scholars have divergent statements on the concept and dimensions of trust, Kramer & Tyler discussed trust from the “cognitive-based trust” (i.e. trust in others based on a cumulative history-dependent cognitive or rational process) and the “identity-based trust” (i.e. trust in the members and the authority when an individual identifies with a group/organization) [23], Luhmann divided it into personal trust (i.e. trust in another human being with the generalized expectation of the personality of trustworthiness) and system trust (i.e. trust in the system/mechanism underlying money, the authority and institutions) [24], and Carpiano & Fitterer discussed trust from generalized dimension and particularized dimension [25]. Among them, generalized trust (i.e. the belief that most people, including unknown groups and strangers, can be trusted) and particularized trust (i.e. the belief that certain known others can be trusted) [26] have been claimed to be beneficial for the health of older adults in many studies. A previous study found that generalized trust was positively associated with better self-reported health and more happiness [27]. More trusting individuals will likely commit themselves to community activities (e.g., health promotion programs) [22]. Through these pathways, trust is considered as one of the determinants of health [28, 29]. A multinational study showed that trust in neighbors was positively associated with cognitive function, such as in India, Ghana, and Russia [30]. Some scholars argue that, as certain psychological feelings, trust may put trustors into the passive role and responsible for taking certain risks [31]. Different types of individual trust (e.g. family members, friends, neighbours, strangers, etc.) may have different associations with the cognitive function of older adults. More importantly, the role of different types of trust is influenced by an individual’s sociocultural contexts [32]. For example, Americans are more likely to trust strangers than Japanese people because American society has higher social mobility and greater social uncertainty, whereas Japanese society does not [33]. However, to our knowledge, there is no relevant research exploring the relationship between different types of trust and the cognitive function of older adults, especially those who relocated for poverty alleviation in China.

Relocation for Poverty Alleviation: Poverty and inequality are common challenges faced by the whole world. In the 2030 agenda for sustainable development, the first sustainable development goal (SDG) is to end poverty in all its forms everywhere [34]. Among a series of Chinese poverty alleviation measures, relocation for poverty alleviation is an important measure in the Targeted Poverty Alleviation strategy in China. The relocation for poverty alleviation policy aims to help people living in uninhabitable areas to relocate to resettlement sites with better living and production conditions, promote economic growth, and eventually achieve common prosperity [35, 36]. Shanxi, a key province for poverty alleviation in China, has relocated more than 362,000 registered poverty-stricken people from inhospitable areas during the 13th Five-Year Plan (2016–2020). The relocation mainly includes two types: centralized resettlement (i.e. centralize the relocated poverty-stricken household from one poverty-stricken village in one resettlement site) and scattered resettlement (i.e. scatter the relocated poverty-stricken household from one poverty-stricken village into several resettlement sites) according to the actual situation of impoverished areas. Although this project takes the willingness of poverty-stricken people as a prerequisite [37], because this relocation prioritizes economic improvement, the rapid socioeconomic and environmental transformation may have potential impacts on the health of vulnerable groups [38–40].

Relocation, accompanied by some great changes to the social environment, can impact the physical and mental health of older adults. Previous studies have suggested that rural-to-urban migrants tend to have exposure to more education opportunities, higher accessibility to health care and therapy, and better management of chronic conditions, which may positively influence their cognitive function [41, 42]. However, relocation may also have negative effects on their health. some studies argued that it was not the case, middle-aged and older migrants showed poorer cognitive function compared to local residents [43, 44]. A study on the relocated poverty-stricken people in Guizhou, China figured out that the migrants would experience a great social capital loss and need to rebuild their social capital in the new place of residence [45]. After relocation, great changes in the living environment, residential pattern (e.g. from living in a house to living in an apartment), and type of relocation may result in reduced or lost contact with their relatives, friends, and neighbors and dealing with new community/village staff in relocated older adults, which may further affect their trust in other people and lead to some difficulties and disadvantages in building trust in the new environment. What is the level of different types of trust among relocated older adults? Do different types of trust have impacts on their cognitive function? Is there a sex-related difference? These issues are still underdeveloped and more worthy of research in the Chinese Context, given the “cultural feature” of trust [46].

To address the current research gap, we aim to investigate the association between different types of trust (from generalized and particularized dimensions) and cognitive function and the sex differences in older adults relocated for poverty alleviation in a provincial sample of Shanxi, China. We sought to add more evidence for a better understanding of trust and cognitive function in the face of changing environment and population ageing. It will provide empirical evidence to help inform policies considering early diagnosis and develop strategies and interventions in cognitive impairment among relocated older adults in China and in other countries.

Methods

Study design and population

The data of this study was collected from a population-based cross-sectional questionnaire survey conducted by face-to-face interview in 24 resettlement sites of 8 counties and 4 cities in Shanxi Province, China. A three-stage stratified sampling method was employed [47]. The sample size calculation formula was Inline graphic, δ = 0.02 (the permissible error), α = 0.05, Z2α/2=1.96. Literature reports that the prevalence of cognitive impairment among Chinese older adults was 22.0% [48]. We assumed p=0.22, n=1648, according to the formula calculation. Considering the possible sample loss and refusal, the sample was increased by 25%, and finally, n=2060 relocating older adults were selected during the sampling stage. We used a multi-stage sampling involving four steps. The sampling procedures are shown in Fig. 1. We enrolled the older adults aged 60+ relocated for poverty alleviation and living in the resettlement sites. A total of 2060 questionnaires were distributed and 1882 older adults were surveyed from June to August 2023, 8 questionnaires were invalid and excluded. The respondents who did not answer all the questions involved in this study were excluded from the analysis (n=26), and a final total of 1848 respondents were analyzed.

Fig. 1.

Fig. 1

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Flowchart of sampling procedures

Data collection

The study was approved by the Ethics Committee of Shanxi Medical University (No. 2022GLL012), and written informed consent to participate was obtained from all the participants in the study before enrollment and data collection. Before the conduct of the survey, all investigators (senior undergraduates, postgraduates and Ph.D. candidates) were well trained in a centralized manner, the structure and content of the questionnaire were explained, and the matters that required attention and principles in the questionnaire survey were emphasized, to ensure that they could exactly understand the standards and procedures of the investigation. In-person interviews were conducted door-to-door using structured questionnaires by the trained investigators.

Measures

Cognitive function

The Chinese version of Mini-Mental State Examination (CMMSE) was used to measure the cognitive function of older adults in this study, including orientation, registration, naming, attention and calculation, recall, and language [49]. MMSE has been a widely used and one of the most influential cognitive tests for screening cognitive impairment, it was created and developed by Folstein and his colleagues [50–52]. The Chinese version of MMSE is a culturally and socioeconomically adapted version of the standard MMSE and has been tested and found to have excellent reliability and validity, with a score ranging from 0 to 30. Older adults with a higher score would be considered to have better cognitive function [49, 53]. The Cronbach’s alpha of CMMSE is 0.809 in the present study.

Trust

Different types of trust were measured given different objects and contexts. In this study, we measured two dimensions and six different types of trust [54, 55].

Generalized trust: (1) generalized trust in society: Generally speaking, would you say that most people are trustworthy? (2) generalized trust in community: Generally speaking, would you say that most people living in this resettlement site are trustworthy? The variable responses included “absolutely disagree” “disagree” “it depends” “agree” and “entirely agree”.

Particularized trust: (1) particularized trust in family: Do you feel that your family members are trustworthy? (2) particularized trust in friends: Do you feel that your friends are trustworthy? (3) particularized trust in neighbours: Do you feel that your neighbours are trustworthy? (4) particularized trust in authoritative identity: Do you feel that the government officials (i.e. community/village staff) are trustworthy? The variable responses range from “absolutely disagree” to “entirely agree”.

Consistent with previous studies [56–58], we convert all the trust into a binary variable (yes/no) by assigning the value ‘1’ to all respondents who answered ‘‘entirely agree’’ and “agree”, and assigning the value ‘0’ to all those who answered ‘‘absolutely disagree” “disagree’’ or ‘‘it depends’’.

Covariates

The covariates were selected as potential confounders based on our previous study and literature [59–61] and the characteristics of relocated older adults and resettlement sites that may have some effect on their cognitive function [62–65], and divided into three groups. The first group (demographic and socioeconomic characteristics) were sex, age (continuous), education background (primary school or below, middle school and high school or above), living arrangement (live alone or live with someone), marital status (married/divorced/widowed/never married), and monthly individual income (continuous). The second group (health behaviors and health status) consisted of current smoking (yes/no), current alcohol drinking (yes/no), current tea drinking (yes/no), physical activity (yes/no), sleep quality (very good, good, so-so, bad, very bad), body mass index (BMI), depressive symptoms, non-communicable diseases (NCD, yes/no), and activities of daily living (ADL). Symptoms of depression were assessed by the 10-item Center for Epidemiologic Studies Short Depression Scale (CES-D) [66]. ADL was measured by the independence of relocated older adults in six activities, including feeding, bathing, transferring, dressing, toileting, and continence using a dichotomous scale (0 = dependent, 1 = independent), with a score of 6 indicating complete independence [67]. The third group (relocation characteristics) included type of relocation (relocation in a concentrated way/in a scattered way), relocation duration (length after relocation), standardized grass-root healthcare institution (i.e. the healthcare institutions at the grassroots level meeting basic or recommended standards put forward by the government in terms of service capabilities) in the resettlement sites (yes/no), and senior recreation center in the resettlement sites (yes/no).

Statistical analysis

First, the continuous variables were described using mean ± standard deviation (SD) or mean (the first quartile[P25], the third quartile[P75]), and all the categorical variables were presented using number and proportion (%). Second, the association between different types of trust and the cognitive function of relocated older adults was investigated using hierarchical linear multiple regression analysis. Based on previous research and theoretical considerations [68, 69], we included previously reported variables that may affect trust and the cognitive function (i.e. sex, age, education background, living arrangement, marital status, monthly individual income, current smoking, current alcohol drinking, current tea drinking, physical activity, sleep quality, BMI, depressive symptoms, NCD, ADL, the type of relocation, relocation duration, standardized grass-root healthcare institution in the resettlement sites, and senior recreation center in the resettlement sites). To avoid multicollinearity and select the “optimal” regression equation, this study categorized variables based on their characteristics and stratified them in a “distal-to-proximal” order [70]. Specifically, Model 1 was a crude model. In Model 2, the first-group covariates (i.e. demographic and socioeconomic characteristics in structural determinants-individual level, including sex, age, education background, living arrangement, marital status, and monthly individual income) were incorporated based on Model (1) In Model 3, the second-group covariates (i.e. health behaviors and health status in intermediary determinants level, including current smoking, current alcohol drinking, current tea drinking, physical activity, sleep quality, BMI, depressive symptoms, NCD, and ADL) were added based on Model (2) In Model 4, the third-group covariates (i.e. relocation characteristics in structural determinants-socioeconomic and political context level, including the type of relocation, relocation duration, standardized grass-root healthcare institution in the resettlement sites, and senior recreation center in the resettlement sites) were added based on Model (3) This strategy ensures accurate estimation of the association between core variables by progressively controlling for confounding factors at different levels, in accordance with epidemiological modeling norms [71]. Third, to further examine sex differences in the association of trust and cognitive function, we performed stratified analyses by sex group, adjusting for all confounders, and the suest test to ascertain whether the regression coefficients between the males and the females were statistically different [72]. Statistical analyses were conducted via IBM SPSS version 24.0 and STATA version 16.0. The level of statistical significance was set at P < 0.05. Collinearity diagnostics were conducted, and the tests for linear regression showed an acceptable VIF (1.019 ~ 2.673).

Results

According to demographics results (Table 1), there were 51.1% males and 48.9% females, with an average age of 71.08 ± 7.29 years old; the individual income was 77.13 (P25: 18.32, P75: 84.53) USD/month, lower than the median of per capita disposable income of rural households (208.20 USD/month) reported in the Statistical Communiqué of The People’s Republic of China on the 2022 National Economic and Social Development (according to the exchange rate on Sep 1, 2024, accessed in https://treasury.un.org/); 70.9% belong to the educational background group of primary school and below; 18.6% living alone; 23.3% widowed and 72.8% married. Most of the participants did not smoke (67.6%), have alcohol drinking (89.6%), or have tea drinking (81.1%), the proportion of older adults who did exercise was relatively large (79.7%), and 51.7% slept well (including “good” and “very good”). According to health status, 70.3% had NCD, and the average BMI was 22.46 kg/m2 (SD = 3.91), with the mean scores for ADL of 5.75 ± 0.97 and depression of 11.76 ± 5.87. Among the participants, most of them relocated in a concentrated way (94.2%), with an average relocation Duration of 50.29 ± 12.97 months, 87.7% and 72.7% reported there was a standardized grass-root healthcare institution and senior recreation center, respectively.

Table 1.

Descriptive statistics of participants

Variables n/Mean %/SD/M25, M75
Gender
Male 945 51.1
Female 903 48.9
Age 71.08 7.29
Individual income (yuan/month) 547.49 130, 600
Educational background
Primary school or below 1310 70.9
Middle School 420 22.7
High school or above 118 6.38
Marital status,
Married 1345 72.8
Divorced 22 1.2
Widowed 431 23.3
Never married 50 2.7
Living arrangement
Living alone 344 18.6
Living with someone 1504 81.4
Standardized grass-root healthcare institution
Yes 1621 87.7
No 227 12.3
Senior recreation center
Yes 1344 72.7
No 504 27.3
Type of relocation
Concentrated way 1741 94.2
Scattered way 107 5.8
Relocation duration (month) 50.29 12.97
Smoking
Yes 599 32.4
No 1249 67.6
Alcohol drinking
Yes 192 10.4
No 1656 89.6
Tea drinking
Always 180 9.7
Sometime 134 7.3
Seldom 35 1.9
Never 1499 81.1
Physical activity
Yes 1473 79.7
No 375 20.3
Sleep quality
Very good 311 16.8
Good 644 34.9
So-so 325 17.6
Bad 433 23.4
Very bad 135 7.3
Having NCD
Yes 1299 70.3
No 549 29.7
ADL score 5.75 0.97
BMI 22.46 3.91
Depression score 11.76 5.87
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As shown in Table 2, for the different types of trust, the proportion of older adults who trust was higher than those who did not trust in all types. Among them, the proportion of those who trust their family members was the highest (89.3%) and the proportion of those who trust the community/village staff was the lowest (68.0%). Older women reported a higher level of trust in most people in society, family members, friends, and neighbours, but a lower level of trust in community/village staff and most people Living in this resettlement site than older men, however, the sex-related differences in different types of trust were not statistically significant. Their mean CMMSE score was 24.40 ± 5.84, and older men got higher scores than older women, that is to say, older men’s cognitive function was better than older women’s (P < 0.001).

Table 2.

Trust descriptive statistics of older adults relocated for poverty alleviation

Variables All participants (n = 1848) Male (n = 945) Female (n = 903) P
n/mean %/SD n/mean %/SD n/mean %/SD
Trust in most people (including strangers) 0.28
Yes 1346 72.8 678 71.7 668 74.0
No 502 27.2 267 28.3 235 26.0
Trust in most people living in this resettlement site 0.61
Yes 1324 71.6 682 72.2 642 71.1
No 524 28.4 263 27.8 261 28.9
Trust in family members 0.48
Yes 1650 89.3 839 88.8 811 89.8
No 198 10.7 106 11.2 92 10.2
Trust in friends 0.83
Yes 1367 74.0 697 73.8 670 74.2
No 481 26.0 248 26.2 233 25.8
Trust in neighbours 0.54
Yes 1382 74.8 701 74.2 681 75.4
No 466 25.2 244 25.8 222 24.6
Trust in community/village staff 0.67
Yes 1257 68.0 647 68.5 610 67.6
No 591 32.0 298 31.5 293 32.4
CMMSE score 24.40 5.84 24.99 5.46 23.79 6.15 < 0.001
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Hierarchical multiple linear regressions on CMMSE score as a dependent variable were carried out (Table 3). Across all models, two types of generalized trust were not found to be associated with cognitive function in relocated older adults, and two of four types of particularized trust were proved to be associated with cognitive function significantly. Generalized trust in society was negatively associated with cognitive function, older adults feeling most people trustworthy showed Lower CMMSE score in Model 1 (the crude model) [β=−0.07, 95% Confidence Interval (95% CI): −0.13;−1.68, P < 0.05], but the association disappeared after controlling the confounders in Model 2, adjusting for sex, age, education background, Living arrangement, marital status, and monthly individual income, Model 3, further adjusting for current smoking, current alcohol drinking, current tea drinking, physical activity, sleep quality, BMI, depressive symptoms, NCD, and ADL, and Model 4, finally further adjusting for type of relocation, relocation duration, standardized grass-root healthcare institution in the resettlement sites, and senior recreation center in the resettlement sites. Meanwhile, particularized trust in friends and particularized trust in authoritative Identity showed a positive association with the cognitive function of relocated older adults. Older adults who trusted in friends had higher CMMSE scores in Model 1 (β = 0.14, 95% CI: 0.91;2.75, P < 0.001), but this association was attenuated as all the confounders were controlled (Model 4: β = 0.08, 95% CI: 0.23;1.94, P < 0.05). Older adults who trusted in community/village staff got higher CMMSE scores (β = 0.08, 95% CI: 0.26;1.69, P < 0.01) after adjusting for confounders.

Table 3.

Regression coefficient and 95% confidence intervals (CI) of trust on cognitive function according to four different models among 1848 older adults relocated for poverty alleviation in Shanxi, China in 2023

Model 1 Model 2a Model 3b Model 4c Male Female P d
Trust in most people (including strangers)  0.003
Yes

−0.07*

(−0.13;−1.68)

−0.05

(−1.42;0.04)

−0.05

(−1.35;0.11)

−0.05

(−1.43;0.001)

−0.14***

(−2.67;−0.82)

0.03

(−0.72;1.51)
Trust in most people living in this resettlement site  0.71
Yes

−0.05

(−1.56;0.17)

−0.04

(−1.38;0.26)

−0.04

(−1.33;0.31)

−0.04

(−1.29;0.32)

−0.05

(−1.69;0.41)

−0.02

(−1.54;0.92)
Trust in family members  0.27
Yes

0.01

(−0.77;1.30)

0.03

(−0.52; 1.45)

0.01

(−0.72;1.26)

0.01

(−0.72;1.21)

0.05

(−0.42;2.09)

−0.02

(−1.83;1.17)
Trust in friends 0.78
Yes

0.14***

(0.91;2.75)

0.11**

(0.57;2.32)

0.11**

(0.53;2.27)

0.08*

(0.23;1.94)

0.10*

(0.07;2.39)

0.07

(−0.29;2.26)
Trust in neighbours 0.27
Yes

−0.04

(0.40;−1.49)

−0.03

(−1.35;0.45)

−0.03

(−1.34;0.44)

−0.04

(−1.35;0.39)

−0.08

(−2.13;0.21)

0.003

(−1.29;1.36)
Trust in community/village staff 0.50
Yes

0.09**

(0.29;1.84)

0.08**

(0.24;1.71)

0.09**

(0.33;1.80)

0.08**

(0.26;1.69)

0.11**

(0.31;2.14)

0.05

(−0.44;1.83)
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*p < 0.05; **p < 0.01; ***p < 0.001. Stratified analyses by sex were conducted adjusting for all confounders

a Adjusted for sex , age, education background, marital status, monthly individual income, and living arrangement

b Adjusted for sex, age, education background, marital status, monthly individual income, living arrangement, current smoking, current alcohol drinking, current tea drinking, physical activity, sleep quality, BMI, depressive symptoms, NCD, and ADL

c Adjusted for sex, age, education background, marital status, monthly individual income, living arrangement, current smoking, current alcohol drinking, current tea drinking, physical activity, sleep quality, BMI, depressive symptoms, NCD, ADL, type of relocation, relocation duration, standardized grass-root healthcare institution in the resettlement sites, and senior recreation center in the resettlement sites

d P value of the suest test of the difference in the regression coefficients between males and females

Given the results of stratified analyses by sex group adjusting for all confounders, the sex-related difference was significantly hidden in the association between trust and cognitive function in relocated older adults. Older men who trusted most people showed lower CMMSE scores (β=−0.14, 95% CI: −2.67;−0.82, P < 0.001), in short, the negative association between generalized trust in society and cognitive function in relocated older men was revealed in this study, the regression coefficients were significantly different between the male and female (P < 0.01). Besides, older men who trusted in friends (β = 0.10, 95% CI: 0.07;2.40, P < 0.05) and who did not trust in community/village staff (β = 0.11, 95% CI: 0.31;2.14, P < 0.01) had lower CMMSE scores, however, the regression coefficients were not significantly different between the male and female (P > 0.05). The association between trust and cognitive function was not found among relocated older women.

Discussion

We performed a population-based cross-sectional study to investigate the association between trust and cognitive function in relocated older adults lifted out of poverty in Shanxi, China. In this study, men showed better cognitive function than women, which was consistent with a former study on rural older adults [10]. After adjusting for various confounders, the study found some types of trust, including trust in friends and trust in community/village staff were negatively correlated with the cognitive function of relocated older adults. Generalized trust in society was negatively associated with cognitive function in the crude model, however, the relationship was not statistically significant after all the confounders were controlled. We analyzed that the association between generalized trust in society and cognitive function among relocated older adults observed in Model 1 may be a spurious association caused by confounding factors. After controlling for the covariates in Model 2 (including sex, age, education background, living arrangement, marital status, and monthly individual income), this association was no longer significant. Educational background and monthly individual income, as core indicators of socioeconomic status, may be the main confounding variables [73–75]. The inclusion of subsequent Models 3 and 4 further validated the stability of this result, suggesting that the initially observed association is likely driven by confounding factors such as socioeconomic status. First, relocated older adults might lose their main source of economy, e.g. farmland, after relocation [76]. After moving to a community, they may feel economically unequal compared to the indigenous people of the community, which may lead them to be more inclined to accept the value of self-improvement and erode their social capital, such as trust [77, 78]. A cross-sectional study provides supporting evidence for this view [79]. Secondly, a number of studies have confirmed that socioeconomic status has an impact on cognitive function in older adults [80, 81]. Socioeconomic status, as a structural influence, is unlikely to directly affect individual cognitive function [82, 83]. Instead, socioeconomic status may indicate lower access to and quality of institutional resources, higher stress levels, and poorer norms or ability to engage in healthy behaviors, such as physical activity, healthy eating, and not smoking, all of which affect cognitive function [84–86]. In addition, generalized trust in society, trust in friends, and trust in community/village staff were significantly associated with cognitive function in older men. Trust in a generalized dimension or a particularized dimension was not found to be associated with cognitive function in relocated older women. Although the underlying mechanism of the association between trust and cognitive function remains unclear and needs to be further, exploring different types of trust as risk factors for cognitive function in older adults is still of great significance. The results revealed the varying association between different types of trust and cognitive function in relocated older adults, which expanded our theoretical understanding of the association.

Generally, low trustors tend to avoid social interactions with uncertain outcomes and exhibit increased anxiety due to the possibility of being taken advantage of by others [87, 88], and may participate in a smaller social network [89], which would result in various health problems for older adults, such as psychological distress, poor self-reported health and memory function [19, 90, 91]. As older adults age, they have smaller networks and lower rates of social contact [92], especially for rural older adults who are often idealized as possessing stronger ties to their communities and high dependence on the support and companionship from their family and friends [93]. Thus, when relocated older adults lack of trust in friends, they probably could not get the necessary support (instrumental or emotional) in time to meet their life demands or to mitigate the negative influence of stress and discomfort after relocation [94, 95], which may negatively affect their cognitive function [96]. Besides, a lack of trust in friends may reduce the social interactions and engagements in informal social activities of relocated older adults, which might result in a lack of stimulation and disuse of the brain, contributing to cognitive decline in old age [4, 97, 98]. The lack of trust in community/village staff may affect their access to more medical information, health knowledge, and participation in community activities. A Japanese study reported that participation in local community organizations was protective against functional decline in rural older people [99]. Meanwhile, with a high level of trust in community/village staff, relocated older adults could seek help from them when encountering difficulties, such as daily life events, healthcare service seeking, medical treatment and disease prevention, and are more able to obtain some official help and support. On the other hand, considering this study was a cross-sectional study, the reverse correlation between trust and cognitive function may also exist. For example, Chen et al. demonstrated a reverse correlation between trust and cognitive function that older adults with mild cognitive impairment reported a decrease in trust propensity due to deficits in social rationality and increased sensitivity to betrayal [100]. And Pressman’s research indicates that patients with behavioral variant frontotemporal dementia (bvFTD) have difficulty accurately understanding others’ intentions due to impaired mentalization abilities, this social cognitive deficit may lead them to exhibit overly friendly and gullible behavioral characteristics, reflecting an abnormal trust mechanism [101].

This study confirmed the sex-related differences in the association between trust and cognitive function among relocated older adults, and no significant association was found in older women. In traditional Chinese society, especially in rural areas, men are the main source of income family income and the representative of family decision-making and management, while women’s main responsibility is to take care of the family (children and seniors), engage in household chores, and obey the orders of their husbands and seniors, which leads to differences in social connections and networks between men and women. In this study, older men who trust in friends and community/village staff have higher CMMSE scores. This result is consistent with the characteristics of social interaction of older men in Chinese society. Rural older men’s social interactions are more outward-oriented and participate more in social events in the external world [102], trust in friends and community/village staff can improve their willingness to participate in social activities and interaction after relocation and the accessibility of social support (emotional and instrumental), alleviate their stress and a sense of isolation in the new environment, and accelerate their adaptation to the new life, benefiting to their cognitive function [103, 104]. However, when it comes to generalized trust in society, this study found that older men who trusted most people reported lower CMMSE scores, which is inconsistent with the results of a study that having someone to trust was associated with better subjective well-being and good memory function across sex-stratified and place-stratified analysis [19]. We consider the differences caused by the cultural features of trust. The trust of Chinese people is “built on kinship or pure personal relationships like kinship”, which is a particularized trust formed and maintained through the family advantages and clan ties of the blood or the geography standard acquaintances trust, and is difficult to generalize, therefore, for those outsides of this relationship, namely “outsiders”, Chinese people generally do not trust other people outside of his relationship circle [105, 106]. Thus, when older men do not trust those most around them (including strangers), we assume that they may possess strong and close family, friends, and acquaintances, so they do not need to seek social relationships and support from the outside world. The strong and close kinship is good for their physical/mental functioning [102], and contributes to their good cognitive function.

The major strength of this study is that we did a detailed trust measurement, involving generalized dimension (trust in society and trust in community) and particularized dimension (trust in family, friends, neighbours, community/village staff). However, there are several limitations should be acknowledged. First, it was a cross-sectional study and the mechanism and the causal relationship between trust and cognitive function could not be discussed and concluded. We will conduct a follow-up investigation of the participants of this study and do further longitudinal studies of the population. Secondly, the pre-migration and the migration process survey was not conducted, thus the estimation accuracy of the association between trust and cognitive function of relocated older adults would be affected.

Conclusions

This study examines the association between trust (generalized & particularized) and cognitive function of older adults relocated for poverty alleviation in China. Our results suggest that trust in friends and trust in community/village staff was associated with better cognitive function. In addition, trust in most people in the society was negatively associated and trust in friends and community/village staff was positively associated with the cognitive function of relocated older men, while we observed no relationship between any types of trust and cognitive function among older women. Additionally, future policy interventions must highlight relocated older adults who have low trust in friends and community/village staff, more targeted interventions, such as enriching forms of leisure time recreation, helping relocated older people in daily life, medical services and emotional difficulties, and providing convenient channels for healthcare services. More attention needs to be paid to the changes in the cognitive function of relocated older men, especially those who find it difficult to adapt to new environments after relocation.

Acknowledgements

The author greatly appreciates the support and advice from the reviewers and the editors. Thanks to Professor Qi Yu, the grant recipient of the Special Fund for Science and Technology Innovation Teams of Shanxi Province (Grant No. 202304051001017), for his support.

Author contributions

Conceptualization: LY. Methodology: LY, DG. Formal analysis and investigation: LY, JW, DG, XZ, LW. Writing - original draft preparation: LY, JW. Writing - review and editing: LW, XZ. Funding acquisition: LY. Supervision: XZ, LW. Validation: XZ. All authors read and approved the final manuscript.

Funding

This study is supported by the National Natural Science Foundation of China (72204152), the PhD research startup foundation of Shanxi Medical University (XD2042), and the PhD research startup foundation of Shanxi Province (SD2029). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethical and consent statements

This study is in compliance with the guidelines for human studies which was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. The study was approved by the Ethics Committee of Shanxi Medical University (No. 2022GLL012). Written informed consent was obtained from each participant before enrollment and data collection.

Consent for publication

Not applicable.

Disclosure statement

The authors have declared that no competing interests exist.

Competing interests

The authors declare no competing interests.

Statement

An unauthorized version of the Chinese MMSE was used by the study team without permission, however this has now been rectified with PAR.

The MMSE is a copyrighted instrument and may not be used or reproduced in whole or in part, in any form or language, or by any means without the written permission of PAR (www.parinc.com).

Footnotes

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

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