Sex differences in the prevalence and associated factors of cognitive frailty among community dwelling older persons of lower socioeconomic status

Abstract

Background: Older persons from lower socioeconomic background are more vulnerable to poor health outcomes including susceptibility to higher severity of frailty and cognitive impairment in later life. Hence, the aim of this study was to determine the prevalence of CF and its associated factors among community dwelling older persons of lower socioeconomic status and stratified by sex. Methods: 255 community dwelling older persons aged 60 years and above (68.58±5.67 years) of lower socioeconomic status participated in this study. CF was operationalized using the Fried’s Frailty Phenotype and Clinical Dementia Rating Scale. Data collected included socio-demographic information, health status, cognitive function, physical and functional status, nutritional status, psychosocial status, and health related quality of life (HRQoL). Prevalence of CF was analyzed descriptively, and associated factors of CF was assessed using hierarchical binary logistic regression (BLR) among total participants and by sex. Results: Prevalence of CF in this study was 38.4% in total; 41.1% for females and 30.2% for males. The associated factors of cognitive frailty were poorer immediate recall verbal memory (0.816; 95% CI: 0.714, 0.932; p=0.003), poorer attention and working memory (0.722, 95% CI: 0.615, 0.849; p<0.001), poorer functional ability (0.673, 95% CI: 0.477, 0.950; p=0.024) and poorer HRQoL domain of usual activities (1.165; 95% CI: 0.609, 2.227; p=0.025). When stratified by sex, significant factors of CF for males were poorer immediate recall verbal memory (0.719, 95% CI: 0.555, 0.931; p=0.012) and poorer attention, and working memory (1.274, 95% CI: 0.536, 0.980; p=0.036), and for females were lower years of education (0.869, 95% CI: 0.792, 1.011; p=0.017), poorer attention and working memory (0.699, 95% CI: 0.580, 0.844; p<0.001) and HRQoL domain of ‘mental function’ (1.091, 95% CI: 0.916, 1.299; p=0.007). Conclusion: CF is prevalent among older persons of lower socioeconomic status. Poor verbal memory, attention and working memory, poorer performance of functional and usual activities was identified as associated factors of CF. Although there are some differences in associated factors of CF based on sex, interventions addressing physical and cognitive domains may have the potential for reversal or prevention of CF within the socioeconomically disadvantaged population.