Cumulative effects of cognitive impairment and frailty on functional decline, falls and hospitalization: A four-year follow-up study with older adults

Abstract

Cumulative effects of cognitive impairment and frailty on functional decline, falls and hospitalization: a four-year follow-up study with older adults OBJECTIVE: Evaluate the cumulative effects of cognitive impairment and frailty on functional decline, falls and hospitalization in older adults over a four-year period. METHOD: Four hundred five older adults (60-95 years; mean age: 70.62 ± 7.12 years), 57% female. The frailty evaluation was performed using the clinical criteria of the Cardiovascular Health Study (CHS): weight loss, fatigue, weakness, slowness and low physical activity. Cognitive impairment was defined by cutoff scores of the Mini Mental State Examination (MMSE) based on schooling. Follow-upfunctional decline was assessed using the Lawton&Brody scale of instrumental activities of daily living (IADL). An investigation was also performed of the occurrence of falls and admissions to the hospital in the previous twelve months. RESULTS: Cognitive impairment was associated with admissions to the hospital and declines in the IADL category of using a telephone. Frailty was associated with admissions to hospital. Cumulative effects were observed for hospitalization and the decline in using the telephone and shopping. Frailty and cognitive impairment increased the risk of being admitted to hospital by 557% and increased the risk of a decline in using the phone by 262% and shopping by 208%. No conditions were associated to risk of falls. CONCLUSION: The combination of the MMSE and the CHS criteria was adequate for measuring the cumulative effects of cognitive impairment and frailty. Shared physiological mechanisms may explain the relation between cognitive impairment and frailty, but further investigations are needed in Brazil and other low/middle-income countries.

What Role Does Activity Engagement Play in the Association between Cognitive Frailty and Falls among Older Adults? Evidence from Rural Shandong, China

“…This study found that the prevalence of cognitive frailty among the rural elderly was 6.6%, which is higher than in another study (3.3%) in China conducted on community- dwelling older adults [10]. It is also higher than the prevalence found in Singapore (1.8%) [6] and Japan (2.7%) [24], but lower than that in urban Henan (China) (9.6%) [36] and Brazil (10.9%) [9]. The possible reasons for this variation in prevalence are the different measurement methods and criteria for cognitive frailty across studies.…”

“…Some studies in Japan found that community-dwelling older adults with cognitive frailty may have a greater risk of experiencing falls [7, 8]. However, another study conducted in Brazil did not support this association, demonstrating that cognitive frailty could not predict an increased risk of multiple falls [9]. Previous research has indicated that cognitive frailty was independently associated with falls among Chinese community-dwelling older adults in both urban and rural areas [10].…”

Prevalence and Risk Factors for Cognitive Frailty in Aging Hypertensive Patients in China

“…That study showed that the prevalence of CF was higher in patients with chronic debilitating diseases than in community-dwelling aging individuals. The latest survey in Brazil [36] used the MMSE and instrumental activities of daily living (IADL) to screen for CF and found a prevalence rate of 10.9%, which was higher than that in this study. This may be due to the use of different assessment tools and geographical differences.…”

Impacts of stroke and cognitive impairment on activities of daily living in the Taiwan longitudinal study on aging

“…Items included bathing, dressing, eating, transferring, indoor walking, and toileting. On the other hand, the Lawton-Brody Instrumental Activities of Daily Living Scale 8 is a popular assessment of IADLs, which has been validated in a previous study 47 , and multiple studies involving this measurement have been published in older adults 48 , patients with stroke 49 , and those with cognitive impairment 50 . The current study used a nine-item modified version of the original eight items, with housework subdivided into light and heavy housework, and additionally including transport, managing finances, shopping, laundry, medication, food preparation, and using the telephone.…”