Grandparent Caregiving and Cognitive Functioning: A Comparative Analysis of the United States and China

Background and Purpose: Grandparent caregiving is a key form of intergenerational engagement in later life, with potential implications for caregiver cognitive functioning. Evidence from intra-national studies has revealed inconsistent cognitive outcomes among grandparent caregivers, suggesting that the association is shaped by demographic, familial, and contextual features. Such heterogeneity points to the socially patterned nature of caregiving-cognition relationship. However, it remains unclear how these patterns translate across broader social contexts. Cross-national research thus provides a critical perspective for more robustly understanding how the relationship between grandparent caregiving and cognitive functioning varies. Informed by ecosocial theory and drawing on cross-nationally harmonized datasets, this study examines the relationship between grandparent caregiving and cognitive functioning among middle-aged and older adults in the United States and China, and investigates whether these associations vary by age group, gender, and urban-rural residence.

Methods: Data were drawn from harmonized datasets of the 2018 Health and Retirement Study (HRS) and the 2018 China Health and Retirement Longitudinal Study (CHARLS). The analytic sample included adults aged 50 and above with at least one grandchild under age 16, comprising 15,365 respondents in CHARLS and 12,039 in HRS. Cognitive functioning was assessed via four measures: global cognition, episodic memory, mental status, and self-reported memory. Grandparent caregiving was measured as a binary indicator of caregiving involvement. Nested linear regression models were estimated separately by country, adjusting for sociodemographic, health, and lifestyle covariates. Moderation analyses were conducted to examine whether age group, gender, and urban-rural residence modified the caregiving-cognition association.

Results: After full adjustment, grandparent caregiving was not significantly associated with global cognition in either country. However, domain-specific patterns were observed. Grandparent caregiving was positively associated with episodic memory (B = .21, SE = .08, p < .01) in China and with self-reported memory (B = .07, SE = .03, p < .05) in the United States. Moderation analyses revealed that, in China, grandparent caregiving was positively associated with global cognition among respondents aged 75 and older and was related to higher mental status and better self-reported memory among women. In the United States, rural residence moderated the association between grandparent caregiving and mental status, with positive associations observed among rural respondents but not among their urban counterparts. Across both countries, caregivers demonstrated more favorable sociodemographic, health, and lifestyle profiles, suggesting potential selection effects.

Conclusions and Implications: Findings suggested that the association between grandparent caregiving and cognitive functioning in later life is domain-specific and varies across demographic and social contexts. These patterns highlight the socially embedded role of grandparent caregiving, with implications for cognition shaped by gendered role expectations as well as differences in residential and resource contexts. This highlights the importance of incorporating domain-specific and context-sensitive approaches into social work research and intervention. Policies and community-based programs that reduce caregiving strain and generate supportive resources, particularly for women and older adults in rural settings, may help optimize the cognitive and social benefits of grandparent caregiving across different cultural contexts.