Self‐reported hearing impairment and social isolation are potentially modifiable risk factors for cognitive decline in community‐dwelling older adults

Abstract

AbstractBackgroundFrailty is a state of excess vulnerability to stressors, and has been associated with increased risk of late‐life cognitive decline. As a multi‐factorial condition which is potentially reversible, frailty represents a modifiable target for prevention of cognitive impairment. We examine the risk of cognitive decline associated with physical frailty and its contributing factors in community‐dwelling older adults.MethodIn this prospective cohort study, community‐dwelling older adults aged >55 years undergo a rapid geriatric assessment that includes social profiling, cognitive (modified Chinese Mini‐Mental State Examination, CMMSE), psychological (Geriatric Depression Scale, GDS), nutritional (Mini Nutritional Assessment‐Short Form, MNA‐SF), and sensory (self‐reported vision, hearing) assessment at baseline and 1‐year. Sarcopenia was assessed using SARC‐F and participants completed a battery of physical fitness tests for flexibility, grip strength, upper limb dexterity, lower limb strength/ power, balance and endurance at baseline and follow‐up. Physical frailty was defined using modified Fried criteria. Cognitive decline was defined as a loss of >2 points on CMMSE at 1‐year relative to baseline.Result229 participants (mean age 67.3+7.0years) completed 1‐year follow‐up. 28 (12.2%) participants exhibited cognitive decline. Age, gender and education were similar between groups with and without cognitive decline. There was no difference in baseline prevalence of frailty, sarcopenia, depression and malnutrition between groups. Self‐reported hearing impairment at baseline was significantly more prevalent amongst older adults exhibiting cognitive decline (39.3% vs 19.9%, p=0.009), and they were more likely to report having no contact with friends or relatives compared with their counterparts with stable cognition (10.7% vs 1.0%, p=0.001). On physical fitness tests, only poorer upper limb dexterity at baseline was significantly associated with risk for cognitive decline (box‐and‐block test: 50.3+10.3 vs 54.5+9.6, p=0.035). In multiple logistic regression adjusted for age, gender, education and baseline cognitive performance, self‐reported hearing impairment independently increased risk for cognitive decline (OR=3.29, 95% CI 1.36‐7.96), while maintenance of social contact was protective (OR=0.04, 95% CI 0.00‐0.42).ConclusionWhile physical frailty was not associated with cognitive decline over the relatively short follow‐up of 1‐year, hearing impairment and social isolation are potentially modifiable and should be targets of intervention to reduce cognitive decline in community‐dwelling older adults.