Dementia Studies Reveal Home Foreclosure Is Associated With Memory Decline
Overview
Housing insecurity is increasingly affecting older adults, yet its impact on cognitive health remains underexplored. This study examines the relationship between foreclosure and cognitive outcomes, specifically memory decline and the probability of dementia, in older adults. The analysis utilized data from the Health and Retirement Study (2008-2018) and employed mixed models to compare cognitive outcomes between 249 older adults who experienced foreclosure (the treated group) and 15,645 who did not (the control group). Key baseline variables included sociodemographic factors and health status, with models stratified by age group.
The findings reveal that foreclosure is linked to accelerated memory decline in middle-aged adults (aged 50-64). Specifically, foreclosure was associated with a decline of 0.007 standard deviations per year in memory, which corresponds to an additional 3.7 years of cognitive aging over a 10-year period compared to peers who maintained stable housing. In contrast, for adults aged 65 and older, the cognitive differences between those who experienced foreclosure and those who did not were less pronounced and appeared to diminish over time, possibly due to depletion-of-susceptibles bias.
These results highlight the significance of housing stability for cognitive health, particularly among middle-aged older adults, and suggest that foreclosure may contribute to an accelerated cognitive decline in this population.
Introduction
Housing plays a crucial role as a social determinant of health, providing stability that supports social, psychological, and financial well-being, healthy behaviors, and access to healthcare. This is particularly vital for older adults, as “aging in place“—the ability to remain in one’s home and community—promotes healthy aging. However, older adults in the U.S. face significant challenges to housing stability, including limited incomes, a high burden of chronic diseases, social isolation, and vulnerability to financial scams. These factors contribute to increasing housing insecurity among this population.
Before the COVID-19 pandemic, the percentage of adults over 65 with outstanding mortgage debt had doubled compared to 30 years prior, along with a significant increase in average mortgage balances. Foreclosure rates were similarly elevated, with a 50% increase since 2007. During the pandemic, 4.4% of adults aged 65 and older reported being behind on their mortgage, with 1.5% expressing doubt about their ability to make the next month’s payment. Among older renters, approximately one in every 50 people over 65 faces an eviction filing annually, equating to around 168,000 individuals. Consequently, older adults are among the fastest-growing homeless subgroups, particularly in states like California, where nearly half of the single adults experiencing homelessness are over 50, many of whom encountered homelessness for the first time in later life.
Despite the growing issue of housing instability, there is limited research on how it impacts older adults’ well-being, particularly cognitive health. The few studies that have examined the relationship between foreclosure and cognition in older adults found that foreclosure is associated with poorer cognitive performance. However, these studies faced limitations, such as cross-sectional designs and the use of area-level foreclosure rates, which complicate individual-level causal inference. Reverse causality also poses a concern, as cognitive impairment can lead to poor financial decisions, increasing the risk of foreclosure.
This study addresses these gaps by using longitudinal data from the 2008 to 2018 waves of the Health & Retirement Study (HRS) to examine the association between foreclosure and cognitive outcomes in older adults. Specifically, it looks at continuous memory scores and composite dementia probability scores, with stratified models comparing middle-aged adults (50 to 64) with those aged 65 and older. The study considers various factors, including baseline cognitive function, potential differential study attrition, and the clustering of longitudinal responses.
Foreclosure is a critical focus due to its severe consequences and the strong biological plausibility of its impact on cognition. Potential pathways include the direct biological effects of foreclosure-induced stress, indirect effects through worsened health behaviors that increase vascular dementia risk, social isolation resulting from displacement, and reduced access to credit, leading to greater financial hardship. Secondary analyses also consider housing unaffordability—difficulty keeping up with mortgage payments—which may activate similar pathways, including competition between high housing costs and household spending on essential needs like healthcare and food.
In conclusion, this study contributes to the understanding of how housing instability, particularly foreclosure, may influence cognitive decline in older adults. It highlights the need for further research into the relationship between housing insecurity and dementia, as well as the potential mediators of this relationship, to develop interventions that protect cognitive health in the face of housing instability.
Method
This study investigates the longitudinal relationship between foreclosure and two cognitive health indicators: memory scores and the probability of dementia. To explore this association, the researchers conceptualized each wave of the Health and Retirement Study (HRS) as a distinct cohort study, pooling these cohorts to estimate the impact of foreclosure on cognitive health. Participants from the 2008 to 2018 HRS waves who had a mortgage were selected, and five cohorts were formed, each covering two-year periods (2008-2010, 2010-2012, etc.). Participants were categorized as “treated” if they experienced foreclosure within the two-year window following the baseline, with follow-up continuing until 2018 or until participants were censored.
The study included 15,766 individuals, 249 of whom experienced foreclosure, contributing to a total of 173,973 observations with a median follow-up of four years. The primary exposure was defined as foreclosure within the past two years, while a secondary exposure level, termed housing insecurity, was identified for those who fell behind on mortgage payments but had not yet been foreclosed upon.
The cognitive outcomes assessed were a composite memory score and a dementia probability score, both derived from validated HRS measures and calibrated using the Aging, Demographics, and Memory Study (ADAMS) dataset. The study accounted for potential confounding factors, including age, sex, marital status, race/ethnicity, education, income, non-housing wealth, and chronic conditions.
Statistical Analysis
Statistical analysis was conducted using mixed-effects linear regression models, incorporating random intercepts at the person and household levels to account for repeated observations and the potential autocorrelation within households. The models also included interactions between foreclosure and time to assess foreclosure-related changes in cognitive decline, with results translated into “excess years of cognitive aging over a 10-year period.”
The study also considered potential confounding due to housing insecurity among those not experiencing foreclosure. Secondary analyses contrasted housing-secure participants with those either foreclosed upon or more than two months behind on mortgage payments.
Several sensitivity analyses were performed, including alternative error calculation methods, models incorporating random slopes, and additional adjustments for childhood socioeconomic status (SES). These analyses aimed to address concerns about potential biases, overfitting, and measurement errors.
In summary, this study offers a comprehensive examination of the long-term cognitive effects of foreclosure, considering various confounding factors and alternative analytical approaches to ensure robust findings.
Result
The study analyzed the impact of foreclosure on cognitive decline, focusing on a sample of 249 individuals (253 person-trials). A significant portion of the sample (78%) were younger than 65 at the time of foreclosure, with the majority being aged 60-64. Participants who experienced foreclosure tended to be younger, more often belonged to racial/ethnic minority groups (except older non-Hispanic Black individuals), and were more likely to be married or partnered. They also generally had lower educational attainment, lower household incomes, and more chronic health conditions. Memory scores at baseline were similar across foreclosure status in middle-aged adults but were slightly lower in older adults who had experienced foreclosure.
Regression models revealed age-related differences in how foreclosure affected cognitive decline. Among middle-aged older adults, foreclosure was linked to a more rapid cognitive decline over time, translating into approximately 3.7 additional years of cognitive aging over a decade, compared to those who did not experience foreclosure. However, foreclosure was not significantly associated with an increased probability of dementia in this younger group.
In contrast, among those aged 65 and older, the impact of foreclosure on cognitive decline and dementia probability was more nuanced. Initially, foreclosed older adults showed a greater decline in memory and an increase in dementia probability scores within two years post-foreclosure. However, these scores eventually aligned with the average trends observed in the comparison group, though with broader confidence intervals as follow-up continued.
The findings remained consistent after accounting for various factors, including the use of inverse probability censoring weights and other sensitivity analyses. Secondary analyses comparing housing-secure older adults with those behind on mortgage payments but not foreclosed showed that the foreclosure results were consistent with the main findings. Additionally, the association between cognitive decline and being behind on mortgage payments was not significant.
Sensitivity analyses, including adjustments for childhood socioeconomic status (SES) and bootstrapped standard errors, yielded similar results, although controlling for childhood SES slightly attenuated the observed association between foreclosure and cognitive decline among middle-aged adults, partially due to missing data on childhood SES.
In summary, foreclosure is associated with accelerated cognitive decline among middle-aged older adults, while the cognitive impact in those aged 65 and older is more complex, with initial declines that later stabilize. The study underscores the importance of considering the long-term cognitive effects of financial stressors such as foreclosure, particularly in middle-aged populations.
Conclusion
The study found that foreclosure is linked to accelerated memory decline in individuals aged 50 to 64. This suggests that for older adults, especially those over 50 during the 2010 foreclosure crisis, the impact of foreclosure on memory could be significant. Although the analysis is correlational, existing research supports the possibility of a causal relationship between foreclosure and cognitive decline. The study identifies four potential pathways through which foreclosure might affect cognition:
- Stress and Cognitive Decline: Foreclosure-induced stress could directly impair memory and accelerate cognitive decline. Prolonged stress, including elevated cortisol levels, can disrupt memory formation and cognitive performance. Chronic stress, in particular, has been associated with brain changes that precede dementia, potentially increasing dementia risk.
- Cardiovascular Health and Dementia Risk: Foreclosure might contribute to dementia through its effects on cardiovascular health. Stress from housing instability and the economic strain it causes may lead to unhealthy coping behaviors, such as smoking and poor diet, which are risk factors for cardiovascular disease. Additionally, housing instability can reduce access to healthcare, exacerbating cardiovascular risk factors and impairing the management of existing health conditions.
- Social Isolation and Cognitive Decline: Foreclosure can lead to social isolation, which may remove a protective buffer against memory decline. Social contact is believed to help prevent cognitive impairment by maintaining cognitive reserves. When individuals lose their stable housing and community connections, they may experience profound social isolation, which could contribute to cognitive decline.
- Economic Hardship and Material Deprivation: Foreclosure damages credit scores and represents a significant loss of wealth, reducing access to credit and financial stability. This lack of financial security can lead to food insecurity and reduced access to medical care, both of which can contribute to cognitive decline.
The study also suggests that these pathways are interrelated, with social isolation and reduced access to credit potentially exacerbating stress and unhealthy behaviors. The research highlights the need for future studies with larger samples and more detailed measures of housing insecurity to clarify these associations.
The findings support the idea that avoiding foreclosure could have cognitive health benefits. Mortgage relief programs for older adults might help preserve cognitive health and reduce healthcare costs. Healthcare providers could benefit from collecting data on patients’ housing experiences to identify those in need of targeted cognitive support.
Despite its strengths, the study acknowledges several limitations, including potential confounding factors and the small sample size of the treatment group. The study’s design also precluded detailed subgroup analyses, and the lack of data on older renters at high risk of eviction limited the examination of eviction’s cognitive impact.
Overall, the study provides valuable insights into the social determinants of cognitive aging and underscores the potential benefits of integrating housing and healthcare policies to protect the cognitive health of older adults.
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