Social Determinants of Health Associated with Cognitive Performance Among Elderly with Hypertension in Klaten Regency, Central Java, Indonesia: A Cross-Sectional Study

Emalia Rizqi Anggita (Master’s Program in Public Health, Faculty of Medicine, Universitas Sebelas Maret)
Argyo Demartoto (Departement of Sociology, Faculty of Social and Political Sciences, Universitas Sebelas Maret)
Rizka Ayu Setyani (Master’s Program in Public Health, Universitas Sebelas Maret)
Endang Sutisna Sulaeman (Faculty of Medicine, Universitas Sebelas Maret)
Haryani Saptaningtyas (Doctoral Program in Development Extension/Community Empowerment, Postgraduate School, Universitas Sebelas Maret)
Maria Paskanita Widjanarti (Diploma IV of Occupational Safety and Health, Vocational School, Universitas Sebelas Maret)

Journal of Epidemiology and Public Health
Vol. 11 No. 4 (2026)

Background: Cognitive decline is one of the major impacts of hypertension in the elderly popula­tion. Social Determinants of Health (SDoH) framework plays an important role for understanding how non-medical factors influence individual health outcomes, including cognitive performance. This study aimed to analyze the relationship between social determinants of health factors and cognitive performance among elderly with hypertension in Klaten Regency, Central Java, Indonesia. Subjects and Methods: This cross-sectional study was conducted at elderly health post and the Chronic Disease Management Program (Prolanis) groups in Klaten Regency, Central Java, Indonesia from February to March 2026. A total of 120 elderly with hypertension aged ≥60 years were selected using multistage sampling. The dependent variable was cognitive performance. The independent variables were education level, living arrangement, physical activity, social activity. Cognitive performance was measured using the Mini Mental State Examination (MMSE), social activity using the Australian Community Participation Questionnaire (ACPQ), and physical activity using the Stanford Brief Activity Survey (SBAS). Data were analyzed using multiple linear regression analysis. Results: Higher education level (b=1.97; 95% CI= 0.86 to 3.08; p=0.001), light physical activity (b=2.67; 95% CI= 1.34 to 4.01; p<0.001), moderate physical activity (b=3.48; 95% CI= 2.02 to 4.94; p<0.001), and higher social activity (b=0.193; 95% CI= 0.148 to 0.239; p<0.001) had positive and significant associations with cognitive performance. There was no significant difference in cognitive performance between elderly living alone and those living with spouse (b=0.14; 95% CI= -1.50 to 1.79; p=0.863) or family (b=0.343; 95% CI= -1.01 to 1.69; p=0.617). Conclusion: Cognitive performance among elderly with hypertension is influenced by education level, physical activity and social activity. Community-based promotive and preventive programs may support the maintenance of cognitive performance.