Effect of a cash transfer intervention on memory decline and dementia probability in older adults in rural South Africa
Year: 2024
Type: article
Abstract: Background: Evidence on cash transfers as a population-level intervention to support healthy cognitive aging in low-income settings is sparse. We assessed the effect of a cash transfer intervention on longitudinal memory decline and dementia probability in older South African adults. Methods: We leveraged the overlap in the sampling frames of a Phase 3 randomized cash transfer trial (HPTN 068, 2011-2015, NCT01233531) and an aging cohort (HAALSI, 2014-2022) in rural Mpumalanga Province, South Africa. In HPTN 068, young women and their primary caregivers were randomly assigned 1:1 to receive a monthly cash transfer or control. Payments were split between the young woman (1/3) and her caregiver (2/3). In 2014/2015, 862 adults aged 40+ years living in the HPTN 068 trial households were enrolled in the HAALSI cohort, with cognitive outcome data collected in three waves over seven years. We estimated the impact of the intervention on rate of memory decline over seven years and dementia probability scores at endline. Findings: Between March 2011 and December 2012, 862 older adults who would go on to enroll in the HAALSI cohort were living in households enrolled in HPTN 068 and randomized to receive the cash transfer intervention (n=429) or control (n=433). Memory decline in the cash transfer arm was 0.03 SD units (95% CI: 0.002, 0.05) slower per year than in the control arm. Dementia probability scores were 3 percentage points lower in the cash transfer arm than the control arm (b=-0.03; 95% CI: -0.05, -0.001). Effects were consistent across subgroups. Interpretation: A modestly sized household cash transfer delivered over a short period in mid- to later-life led to a meaningful slowing of memory decline and reduction in dementia probability seven years later. Cash transfer programs could help to stem the tide of new dementia cases in LMIC settings in the coming decades.
Institutions: South African Medical Research Council, University of the Witwatersrand, Agincourt Health and Socio-Demographic Surveillance System, Indiana University Bloomington, Indiana University, University of North Carolina at Chapel Hill, Harvard University, Umeå University, University of Michigan
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Awards: Strengthening and stabilising a demographic and health surveillance in Agincourt: foundation for a health and population research programme in South Africa's rural northeast, Carolina Population Center, G1789099407, Cognitive Function, Alzheimer's Disease and Related Disorders in the HAALSI Cohort, Health, population and social transitions in rural Southern Africa: Elucidating pathways and testing interventions., Preventing cardiometabolic diseases in Africa: life-course and multi-sector approaches., G4469057728, Investigating and responding to health, population and social transitions in rural Southern Africa., Effects of Cash Transfer and Community Mobilization in Young South African Women, G8186070293, G8276714428, G9000006923, G9000042165, Health, Aging and Dementia in South Africa: A Longitudinal Study (HAALSI), HIV Prevention Trials Network Leadership and Operations Center, Cumulative socioeconomic exposures, cash transfer interventions, and later-life cognitive decline and dementia risk in a low-income region of South Africa, LC: HIV PREVENTION TRIALS NETWORK, SDMC: HIV Prevention Trials Network
OpenAlex ID: W4402698015