Paid Sick Leave and Cognitive Health: Effects of Mandates on Memory-Related Visits and Dementia Risk-Factor Management

• In Event: Paid Leave as Health Policy: Program Design, Uptake, and Health Impacts

Abstract

Introduction: Most adults (and caregivers) are employed during midlife, when cognitive symptoms and modifiable risk factors emerge. However, their ability to seek evaluation and manage chronic conditions is contingent on time off from work. While most developed countries have federal policies that mandate paid sick leave (PSL) for workers, the United States has no federal PSL mandate. Access to PSL is concentrated among higher‑wage, salaried, and unionized workers, while lower‑wage, part‑time, and service‑sector workers, who are disproportionately women and people of color, have less access. State and local PSL mandates, however, have expanded PSL access by requiring employers to allow accrued, job‑protected paid time off for illness, preventive care, and medical appointments. By 2025, 19 states (including D.C.), 17 cities, and four counties had adopted a PSL mandate. Prior research links PSL mandates to greater preventive care use, more outpatient visits, improved mental health, and reductions in emergency department (ED) use and infectious spread. Yet, there is no causal evidence on whether PSL affects memory-related care seeking and management of dementia-relevant risk factors.

Research Question: What is the impact of PSL mandates on memory-related care seeking and management of risk factors for dementia?

Methods: Using 2015-2024 survey data from the National Health Interview Survey, Behavioral Risk Factor Surveillance System (BRFSS) Cognitive Impairment/Cognitive Decline modules, and Merative Marketscan commercial claims, we estimate difference-in-differences and event study models that leverage variation in the adoption of PSL mandates across states over time and are robust to heterogeneous treatment timing. The primary outcomes include whether respondents worsening memory loss (subjective cognitive decline), discussed confusion/memory loss with a clinician, services, memory-related care seeking visits, and management of risk factors for dementia. Further, we will test for heterogeneous effects among groups with historically low PSL access. PSL access is lowest among low‑wage, hourly, and service‑sector workers, populations that disproportionately include racial/ethnic minorities, and dementia burden varies by race/ethnicity.

Results: The preliminary findings suggest that respondents with access to PSL are less likely to report difficulty remembering or concentrating. This association remains robust after controlling for individual-level characteristics such as demographics, education, and employment. The analysis further indicates that even among younger adults, who are less likely to experience cognitive impairment, access to PSL is associated with a lower likelihood of reporting cognitive difficulties. Future work will examine whether paid leave enables individuals to better manage conditions across care settings (e.g., primary care vs. specialist care) and whether effects vary across demographic groups and clinical conditions.

Implications: This research will provide policy‑relevant evidence on whether PSL mandates impact memory-related care seeking and management of risk factors for dementia. Timely evaluation of cognitive symptoms enables detection and treatment of modifiable risk factors for dementia (e.g., medication effects, depression, diabetes), earlier initiation of disease‑modifying therapies, and comprehensive care planning (safety, medication management, advance directives, caregiver support) that may reduce unplanned crises, with potential downstream reductions in avoidable hospitalizations and long-term care.

Author

• Katherine J Wen, Vanderbilt University
  Presenting Author