Elsevier

Mayo Clinic Proceedings

Volume 94, Issue 7, July 2019, Pages 1180-1189
Mayo Clinic Proceedings

Original article
Cognitive Frailty and Mortality in a National Cohort of Older Adults: the Role of Physical Activity

https://doi.org/10.1016/j.mayocp.2018.10.027Get rights and content

Abstract

Objective

To examine the association between cognitive frailty and long-term all-cause mortality and the stratified and combined associations of physical activity and cognitive frailty with long-term all-cause mortality in a population-based cohort of older adults from Spain.

Patients and Methods

A representative cohort of 3677 noninstitutionalized individuals from Spain aged 60 years or older was recruited between April 17, 2000, and April 28, 2001, with follow-up through December 28, 2014. Information on self-reported physical activity and cognitive frailty status were collected at baseline. Analyses were performed with Cox regression after adjustment for confounders.

Results

The median follow-up was 14 years (range, 0.03-14.25 years), corresponding to 40,447 person-years, with a total of 1634 deaths. The hazard ratio (HR) for all-cause mortality among participants with cognitive frailty compared with robust participants was 1.69 (95% CI, 1.43-2.01). Being active was associated with a mortality reduction of 36% (95% CI, 21%-47%) in cognitively frail individuals. Compared with those who were robust and active, participants with cognitive frailty who were inactive had the highest mortality risk (HR, 2.13; 95% CI, 1.73-2.61), which was equivalent to being 6.8 (95% CI, 5.33-7.99) years older.

Conclusion

Cognitive frailty was more markedly associated with increased mortality in inactive older adults, and being active reduced the mortality risk among cognitively frail individuals by 36%. These novel results highlight that engaging in physical activity could improve survival among cognitively frail older adults.

Section snippets

Study Design and Participants

Data were obtained from the Universidad Autonoma de Madrid cohort, a representative cohort of the noninstitutionalized population aged 60 years and older in Spain. Detailed information about the study methods have been reported elsewhere.19, 20 In brief, study participants were selected between April 17, 2000, and April 28, 2001, with follow-up through December 28, 2014, using probabilistic sampling by multistage clusters. The clusters were stratified according to region of residence and size

Descriptive Characteristics

Table 1 shows the baseline characteristics of the study sample. Overall, 832 of the 3677 study participants (22.6%) had cognitive frailty. Compared with robust individuals, age, percentage of women, lower education, never smokers, and alcohol abstainers increased across categories of cognitive frailty. However, the MMSE score decreased across categories (all P<.05).

Association Between Cognitive Frailty and All-Cause Mortality

The median follow-up was 14 years (range, 0.03-14.25 years), corresponding to 40,447 person-years, with a total of 1634 deaths.

Discussion

The main findings of this study were that (1) cognitive frailty was associated with increased mortality more markedly in the inactive older adults and (2) being physically active may reduce the mortality risk among cognitively frail individuals by 36%. These novel results highlight that engaging in physical activity could improve vital prognosis among cognitively frail older adults.

Most studies investigating the effect of cognitive frailty on mortality were conducted in community-based settings.

Conclusion

In this study, the cognitive fragility phenotype, namely the coexistence of both physical frailty and cognitive impairment, was associated with increased mortality, more marked in the inactive older adults. However, physical activity may attenuate 36% of the increased risk of mortality among cognitively frail individuals. This research may have important implications because the levels of physical activity are dramatically reduced in the elderly while cognitive and physical functioning decline

Acknowledgments

We thank the study participants who made this study possible.

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    Grant Support: This work was supported in part by the Instituto de Salud Carlos III, State Secretary of R+D+I and FEDER/FSE (FIS grants 12/1166 and 16/609), MINECO R+D+I grant DEP2013-47786-R, the FRAILOMIC Initiative (European Union FP7-HEALTH-2012-Proposal No. 305483-2), the ATHLOS project (European project H2020-Project ID: 635316), a grant from the Alicia Koplowitz Foundation (I.E.-C.), an FPI grant from Autonomous University of Madrid (S.H.-F.), and a ‘Ramon y Cajal’ contract (RYC-2016-20546) (D.M.-G.).

    Potential Competing Interests: The authors report no competing interests.

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