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The effects of frailty and cognitive impairment on 3-year mortality in older adults

  • Yunhwan Lee
    Correspondence
    Corresponding author at: Department of Preventive Medicine and Public Health, Ajou University School of Medicine, 164 World cup-ro, Youngtong-gu, Suwon 16499, Republic of Korea.
    Affiliations
    Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea

    Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea
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  • Jinhee Kim
    Affiliations
    Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea

    Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea
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  • Doukyoung Chon
    Affiliations
    Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea

    Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea
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  • Kyung-Eun Lee
    Affiliations
    Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea

    Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea
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  • Jae-Hyun Kim
    Affiliations
    Department of Health Administration, College of Health Science, Dankook University, Cheonan, Republic of Korea

    Institute of Health Promotion and Policy, Dankook University, Cheonan, Republic of Korea
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  • Suk Myeong
    Affiliations
    Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea

    St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Republic of Korea
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  • Seihee Kim
    Affiliations
    National Evidence-Based Healthcare Collaboration Agency, Seoul, Republic of Korea
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      Highlights

      • Frailty and cognitive impairment independently predict mortality in older adults.
      • The association between frailty and mortality is moderated by cognitive impairment.
      • Those who are frail and cognitively impaired exhibit the highest risk of mortality.

      Abstract

      Objectives

      Frailty and cognitive impairment in late life increase the risk of mortality. Physical frailty is closely associated with cognitive impairment. The aim of the study was to examine the independent and interaction effects of frailty and cognitive impairment in predicting mortality.

      Study design

      A nationally representative sample of community-dwelling Koreans aged 65 years and older (n = 11,266) was followed for 3 years.

      Main outcome measures

      Frailty was categorized using Fried’s phenotype model. Cognitive impairment was defined as more than 1.5 standard deviations below the age-, gender-, and education-specific norm of the Mini-Mental State Examination. Cox proportional hazards regression was used to analyze the mortality risk by frailty status and the moderating effect of cognitive impairment.

      Results

      Frailty was associated with cognitive impairment, with 922 (19.1%), 1609 (28.1%), and 392 (42.8%) of the nonfrail, prefrail, and frail group, respectively, being cognitively impaired. Compared with the nonfrail group, those who were prefrail (hazard ratio [HR] = 1.38; 95% confidence interval [CI]: 1.10, 1.73) and frail (HR = 1.78, 95% CI: 1.29, 2.46) had higher mortality rates, after adjusting for sociodemographic variables, health behaviors, and chronic conditions. Cognitive impairment was associated with a 30% increased mortality rate. A significant interaction between frailty and cognitive impairment was observed (p = 0.003). Compared with those nonfrail and not cognitively impaired, frail persons with cognitive impairment had a lower survival rate (HR = 1.92, 95% CI: 1.26, 2.93).

      Conclusions

      Frailty was a significant predictor of 3-year mortality in community-dwelling older adults, with the association being moderated by baseline cognitive status. Taking cognitive function into account may allow better prediction of adverse outcomes of frailty in later life.

      Keywords

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