Family availability and memory function and decline among adults aged ≥51 in England and the United States, 2004-2019.

Objectives: We investigated whether spousal and child availability may jointly impact memory aging among middle-aged and older adults, and if their joint impact varies between the US and England, two high-income countries with dissimilar social safety nets. Methods: We examined the associations of joint family availability with subsequent memory function and decline among adults aged ≥51 in the US Health and Retirement Study (HRS; n = 4612) and English Longitudinal Study of Aging (ELSA; n = 3502) from 2004 to 2019. Joint family availability was assessed on a 6-point index incorporating the presence and disability status of a spouse, any coresident child, and any child with frequent social contact. Memory was assessed biennially using a harmonized 20-point word recall scale. Results: A moderate level of joint family availability (vs. no spouse or children) was associated with better memory function in both countries. Yet, it was associated with faster memory decline in the US, but not in England (e.g., 4-point family availability score in the US: β = -0.18; 95 % CI: -0.31, -0.06; P-value for the cross-national difference: 0.01). No dose-response relationship was observed for either outcome. Discussion: Among aging US adults, joint spousal and child availability may support better later-life memory function, yet faster memory decline, consistent with a cognitive reserve mechanism. The lack of dose-response relationships suggests diminishing returns with increasing levels of family availability beyond the presence of a spouse or child. Cross-national heterogeneity in these associations between the US and England may imply effect modification by social safety net contexts, although further investigation is needed.