Assessing multilevel association of genderism on cognitive health of older adults across mesosystems and microsystems using the longitudinal aging study in India: An adaptation of the ecological systems theory and cumulative disadvantage/advantage framework

Structural and social determinants across chronosystems critically shape educational transitions and cognitive aging in India by influencing cognitive reserve through life-course. Drawing on Bronfenbrenner's Ecological Systems Theory and the Cumulative Disadvantage/Advantage frameworks, we conceptualize genderism as a structural and social determinant of cognitive health operating across multiple ecological levels - national (macrosystem), regional/states (mesosystem), and household/family or individual (microsystem) – within India's chronosystem. Using Wave 1 of the Longitudinal Aging Study in India (LASI, 2017–2018), we assessed cognitive health across five domains, i.e., memory, orientation, attention, object naming, and executive function among older adults in 36 states and Union Territories of India. Three-level regression models examined how microsystem operating at individual (e.g., age, sex, education, childhood SES, widowhood, health behaviors), and household level (monthly per capita expenditure, indoor air quality, urban/rural residence), and mesosystem operating at state-level (e.g., women's education and employment rates) factors interact to shape cognitive health outcomes. Cognitive health outcomes showed wide gender gaps with regional sex disparities with the largest gap among those with education less than primary education (men: 24; women: 21) which reversed among those with post-secondary education (women: 33; men: 33). Widowed women and those with poor health indicators had significantly lower cognitive health scores. At the microsystem household-level, urban residence (β = 2.64), and households with cleaner cooking fuel use (β = 1.61) while at the mesosystem state-level, the % of women with at least primary education (β = 1.82) and the % of women who were employed (β = 0.62) were associated with improved cognitive health outcomes. The findings reveal how genderism across chronosystems accumulate over the life course highlighting the need for national-state-level policies that enhance women's access to education, employment, health, and nutrition to mitigate gendered disparities in late life cognitive health among Indian adults.