Minority stress, community involvement, and cognitive decline in rural SGM older adults: A longitudinal SEM and growth curve approach.

Sexual and gender minority (SGM) older adults in rural areas face elevated cognitive health risks shaped by structural stigma, yet the pathways underlying these inequities are poorly understood. This study investigated how lifetime rural exposure, minority stress exposure, and community involvement influenced cognitive outcomes among SGM older adults in the U.S. South. Using data from a three-wave longitudinal panel of 1259 participants, we applied structural equation modeling (SEM) to examine direct, indirect, and total effects of these factors on cognitive change scores. We then specified a generalized structural equation model (GSEM) with a Poisson latent growth curve to model repeated cognitive problem counts over time, addressing the count distribution of the outcome. SEM results indicated that lifetime rural exposure, gender minority status, and higher educational attainment were associated with increased minority stress exposure, whereas racial minorities and older participants reported lower minority stress. Minority stress was positively associated with community involvement, reflecting adaptive coping response, and mediated the relationships between gender minority status, education, and community involvement. However, neither minority stress nor community involvement predicted cognitive change when modeled as a difference score. In contrast, the GSEM growth model demonstrated that higher minority stress exposure significantly accelerated cognitive problem growth over time, while chronic conditions exacerbated and higher education slowed decline. Findings highlight that minority stress exerts cumulative, longitudinal effects on cognitive trajectories among SGM older adults. Community participation may foster engagement but cannot offset the neurocognitive consequences of structural stigma.