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

Abstract

<b><i>Introduction:</i></b> Previous studies have demonstrated the relationship between cognitive frailty and falls among older adults. Activity engagement (AE) is known to be related to falls in older adults but the subject has been limited to empirical study. This study aimed to explore the mediating role of AE between cognitive frailty and falls among older adults in rural Shandong, China. <b><i>Methods:</i></b> A total of 3,242 rural seniors (age ≥60 years; 63.6% women) were included in this cross-sectional study. Regression and bootstrap analyses were performed to explore the mediating role of AE between cognitive frailty and falls. <b><i>Results:</i></b> The prevalence of falls was 13.1% and the prevalence of cognitive frailty was 6.6% among the participants. AE mediated the association between cognitive frailty and falls (95% CI 0.077–0.223). However, the direct effect was no longer significant after being adjusted for AE (95% CI –0.037 to 0.684; <i>p</i> = 0.078). <b><i>Conclusion:</i></b> Cognitive frailty was found to be associated with falls among rural older adults, and AE mediated this association. More attention should be paid to promote AE among Chinese rural older adults with cognitive frailty.

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

“…In this study, the prevalence of CF in aging individuals with hypertension was 9.8% (95% CI = 6.4-13.2%), which was higher than the results reported in several studies performed in China and elsewhere of 2.6% [30], 6.6% [31], 7.1% [32] and 3.2% [33]. Hypertension can lead to declines in attention, executive function and other cognitive functions [34]; damage the cardiovascular system; increase physical vulnerability, and accelerate the development of frailty.…”

Cognitive frailty is a robust predictor of falls, injuries, and disability among community-dwelling older adults

“…Slow gait speed, the main feature of PF, is associated with cognitive deficits in processing speed, attention and executive functions, predisposing to increase the risk of falls among older adults [ 3 , 4 , 51 ]. Moreover, older adults with CF may have declined reaction time with possible visual or hearing impairments, leading to postural hence more susceptible to falls [ 52 ].…”

Cognitive Frailty: An Update

“…It has been possible to verify some important advances in research on cognitive frailty in the scientific literature. Links between cognitive frailty and years of education continue to highlight the relationships between low wealth, low educational attainment and negative health events (Gallucci et al, 2020 ; Ruan et al, 2020 ; Wongtrakulruang et al, 2020 ), and the mediational role of active engagement in the relationship between cognitive frailty and falls (Zhao et al, 2020 ) appears as an emerging research topic. It is desirable that research on cognitive frailty progressively incorporates other relevant proxies of cognitive reserve, such as leisure activity and work complexity, as well as global measures of the cognitive reserve construct.…”

“…According to the findings of the study, cognitive frailty is associated with a greater risk for fall-related fractures than cognitive impairment or PF alone. Zhao et al ( 2020 ) reported that the relationship between cognitive frailty and falls may be mediated by engagement in activity, considered as a lifestyle factor which decreases the risk of falling. In this regard, risk of falling may lead to reduced physical activity, but also to reduced engagement in social activities and increased social isolation, which could lead to further cognitive and functional impairment.…”