Impact of frailty, mild cognitive impairment and cognitive frailty on adverse health outcomes among community-dwelling older adults: A systematic review and meta-analysis

Abstract

AimsThis study analyzes the impact of frailty, mild cognitive impairment, and cognitive frailty on adverse outcomes in community-dwelling older adults.MethodsThis systematic review and meta-analysis were conducted using the PRISMA guidelines and MOOSE statement. We developed a specific search strategy for each electronic database and searched PubMed, Web of Science, MEDLINE, and Embase from initial records to July 2021. The studies on adverse outcomes of frailty, pre-frailty, mild cognitive impairment, and mild cognitive impairment with pre-frailty and cognitive frailty were included. Two researchers independently extracted data based on a spreadsheet and assessed the risk of bias. The primary outcomes were mortality, dementia, disability, and hospitalization. The second outcome included quality of life and falls. All analysis was conducted by using Review Manager (RevMan) 5.3 software.ResultsA total of 22 cohort studies (71,544 older adults with mean age ranging from 65.1 to 93.6 years) were included with a low risk of bias and high methodological quality with a NOS score ≥7. Compared to robust elders, individuals identified as frailty were associated with a higher risk of mortality (RR = 2.11, 95% CI: 1.57–2.83) and disability (RR = 5.91, 95% CI: 2.37–14.74). Mild cognitive impairment with pre-frailty was associated with mortality (RR = 1.74, 95% CI: 1.48–2.05) and dementia (RR = 4.15, 95% CI: 1.87–9.20). Pre-frailty was associated with a higher risk of mortality (RR = 1.29, 95% CI: 1.11–1.50). Cognitive frailty was associated with higher risk of incident mortality (RR = 2.41, 95% CI: 1.97–2.94), dementia (RR = 3.67, 95% CI: 2.81–4.78), disability (RR = 11.32, 95% CI: 4.14–30.97), and hospitalization (RR = 2.30, 95% CI: 1.60–3.32), as well as poor quality of life.ConclusionCognitive frailty could be a comprehensive psychosomatic predictor for adverse outcomes among older people. Interactions between frailty, mild cognitive impairment, and cognitive frailty on adverse outcomes must be further explored.Systematic review registration[https://inplasy.com/inplasy-2022-5-0064/], identifier [INPLASY202250064].

Cognitive frailty and its association with depression, anxiety and stress during the COVID‐19 pandemic among older adults in the transforming cognitive frailty into later‐life self‐sufficiency (AGELESS) study

“…6 Cognitive frailty has been associated with several adverse health outcomes even prior to the pandemic, such as increased risk of mortality, functional disability, poor quality of life, exacerbation of health conditions, dementia, disability and hospitalisation. [7][8][9][10][11][12] Prevalence of cognitive frailty among communitydwelling Malaysians aged 60 years and above was 2.2% in 2018. The continual rise in the population of older adults also means a possible increase in older adults with cognitive frailty over future disasters.…”

“…Cognitive frailty describes co‐occurring mild cognitive impairment (MCI) and frailty upon exclusion of dementia and physical disability 6 . Cognitive frailty has been associated with several adverse health outcomes even prior to the pandemic, such as increased risk of mortality, functional disability, poor quality of life, exacerbation of health conditions, dementia, disability and hospitalisation 7–12 . Prevalence of cognitive frailty among community‐dwelling Malaysians aged 60 years and above was 2.2% in 2018.…”

Risk factors of cognitive frailty in elderly chronic obstructive pulmonary disease patients and its implication for death: a cohort study

“…5 Cognitive frailty has a predictive and significant effect on adverse outcomes such as hospitalisation, falls, dementia, and mortality in the elderly, increasing the likelihood of adverse outcomes. [6][7][8] Research shows that elderly patients with COPD have high risk of frailty and cognitive impairment, with incidence rates of 50.3% and 18.8%, respectively. [9][10][11][12] It was reported that physical frailty is associated with poorer cognitive ability and cognitive decline in elderly patients, and a high proportion of COPD patients with frailty also have mild cognitive impairment.…”

“…Depending on the degree of cognitive impairment, cognitive frailty can be divided into potentially reversible cognitive frailty and reversible cognitive frailty 5 . Cognitive frailty has a predictive and significant effect on adverse outcomes such as hospitalisation, falls, dementia, and mortality in the elderly, increasing the likelihood of adverse outcomes 6–8 . Research shows that elderly patients with COPD have high risk of frailty and cognitive impairment, with incidence rates of 50.3% and 18.8%, respectively 9–12 .…”

Editorial: Activities of daily living and everyday functioning: From normal aging to neurodegenerative diseases

“…They also identified unique contributions of cognitive measures to a newly developed index of pathological functional impairment and neuropsychiatric symptoms to functional reserve in MCI and healthy older adults. Frailty is associated with lower health-related quality of life (Solfrizzi et al, 2019 ; Chen et al, 2022 ) and increases the risk of disability, dementia, and mortality (Yi and Yoon, 2023 ). Most interestingly, abnormalities in the integrity of the left anterior thalamic radiation seem to be associated with frailty in patients with cardiometabolic diseases as shown by Tamura et al .…”