Abstract
Background: Frailty is a multidimensional concept, including physical, cognitive, social, sensorial, psychological, and nutritional phenotypes. Among these phenotypes, cognitive frailty is the most widely investigated, which is related to many adverse health outcomes in older individuals. Whether cognitive frailty is dynamic or how these frail phenotypes interact remains an open issue. We studied the rate of these changes over time and their associated factors in a 6-year follow-up cohort.Methods: A total of 426 Chinese community-living older adults in Dujiangyan aged 65 years or older were involved and followed up in three visits 6 years apart. Frailty and cognitive function were assessed using the FRAIL scale and the Mini-Mental State Examination scale. Demographic information, geriatric syndrome, and social interaction status were studied. Rates of transitions in cognitive frailty states and associated risk factors were studied. We used the stepwise logistic regression model to analyze risk factors.Results: At baseline, 18.8% of participants were only in the physical frailty (PF) or mild cognitive impairment (MCI) group, and 0.09% of participants were in the cognitive frailty group. By the end of 6 years, 62 (14.5%) participants had died, and the rates of only PF or MCI group and cognitive frailty group increased to 36.2 and 3.3%, respectively. Also, 199 (46.7%) participants had deteriorated compared with the baseline. The multivariate regression analysis showed that older (OR = 1.12, 95% CI = 1.07 − 1.16, P < 0.001), smoker (OR = 2.15, 95% CI = 1.37 − 3.39, P = 0.001), poor self-evaluation health status (OR = 1.93, 95% CI = 1.06 − 3.51, P = 0.033), and malnutrition (OR = 2.07, 95% CI = 1.21 − 3.52, P = 0.008) were risk factors for worsening, whereas willing to make new friends (OR = 0.61, 95% CI = 0.38 − 0.96, P = 0.032) was associated with 39% lower chance of deterioration.Conclusion: Cognitive frailty is a dynamically changing state, where transitions may be influenced by multidimensions. Multidimensional monitoring of a wide range of events occurring in aging may be the best way to act early. We hope our study may serve as a starting point for redefining the definition of cognitive frailty by covering different frailty domains.
Highlights
The latest global metrics on life expectancy showed that the populations of older ages are increasing substantially GBD 2017 DALYs and HALE Collaborators (2018)
We found a higher proportion of poor self-evaluation health status (P = 0.043), malnutrition (P < 0.001), and Instrumental Activity of Daily Living (IADL) disability (P < 0.001)
We observed a significant increase in only Physical frailty (PF) or MCI state and cognitive frailty state after 6 years
Summary
The latest global metrics on life expectancy showed that the populations of older ages are increasing substantially GBD 2017 DALYs and HALE Collaborators (2018). Frailty is a multidimensional geriatric syndrome characterized by increased vulnerability to stressors as a result of the reduced capacity of different physiological systems (Kelaiditi et al, 2013; Morley et al, 2013; Cesari et al, 2017) It is associated with increased risk of adverse health-related outcomes including falls, disability, hospitalizations, and mortality (Fried et al, 2004; Abellan van Kan et al, 2008; Graham et al, 2009; Panza et al, 2011; Castellana et al, 2021). In a population-based study, subjects with nutritional frailty were at higher risk for all-cause mortality than those with physical frailty (Zupo et al, 2021) Among these phenotypes, cognitive frailty is the most widely investigated phenotype, and it is increasingly acknowledged as a fundamental determinant of the vulnerability and resilience of an individual to stressors (Canevelli et al, 2014). We studied the rate of these changes over time and their associated factors in a 6-year follow-up cohort
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