Extreme climate exposure and cognitive function among older adults in China: The moderating role of age-friendly home modifications

Objectives As climate change accelerates and populations age, the cognitive health risks of extreme climate exposure is increasingly critical. This study investigated whether exposure to extreme heat, cold, and high precipitation affects cognitive function in older adults and whether age-friendly home modifications moderate these relationships. Methods We linked three waves of the Chinese Longitudinal Aging Social Survey (2016, 2018, 2020; 21,789 observations from 7263 adults aged ≥ 60) to prefecture-level daily meteorological data. Extreme climate exposures were defined using location-specific percentile-based thresholds. Cognitive function was measured with the modified Mini-Mental State Examination. Fixed-effects regressions estimated climate-cognition associations, and propensity-score matching combined with difference-in-differences tested whether home modifications moderated these associations. Results All three extreme climate exposures significantly reduced cognitive function: extreme heat (β=-0.006, p =.004), extreme cold (β=-0.007, p =.013), and extreme high precipitation (β=-0.047, p