Original articleCognitive Frailty and Mortality in a National Cohort of Older Adults: the Role of Physical Activity
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.
References (44)
- et al.
Frailty and cognitive impairment—a review of the evidence and causal mechanisms
Ageing Res Rev
(2013) - et al.
Frailty in elderly people
Lancet
(2013) - et al.
Frailty as a predictor of Alzheimer disease, vascular dementia, and all dementia among community-dwelling older people: a systematic review and meta-analysis
J Am Med Dir Assoc
(2016) - et al.
Cognitive performance across 3 frailty phenotypes: Toledo Study for Healthy Aging
J Am Med Dir Assoc
(2017) - et al.
Cognitive frailty: rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group
J Nutr Health Aging
(2013) - et al.
Severe frailty and cognitive impairment are related to higher mortality in 12-month follow-up of nursing home residents
Arch Gerontol Geriatr
(2012) - et al.
Cognitive frailty and adverse health outcomes: findings from the Singapore Longitudinal Ageing Studies (SLAS)
J Am Med Dir Assoc
(2017) - et al.
Reversible cognitive frailty, dementia, and all-cause mortality: the Italian Longitudinal Study on Aging
J Am Med Dir Assoc
(2017) - et al.
Effects of physical activity on cognition, well-being, and brain: human interventions
Alzheimers Dement
(2007) - et al.
Physical activity and the effect of multimorbidity on all-cause mortality in older adults
Mayo Clin Proc
(2017)
Household physical activity and mortality in older adults: a national cohort study in Spain
Prev Med
A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans
J Nutr Health Aging
Population-based reference values for the Spanish version of the SF-36 Health Survey in the elderly
Med Clin (Barc)
Mapping scores onto stages: Mini-Mental State Examination and Clinical Dementia Rating
Am J Geriatr Psychiatry
Cognitive frailty in Italian community-dwelling older adults: prevalence rate and its association with disability
J Nutr Health Aging
Concurrent validity of the Historical Leisure-time Physical Activity Question of the Spanish National Health Survey in Older Adults
Rev Esp Cardiol (Engl Ed)
Frailty, cognitive impairment and mortality among the oldest old
J Nutr Health Aging
Frailty and cognitive impairment as predictors of mortality in older Mexican Americans
J Nutr Health Aging
Cognitive aspects of frailty: mechanisms behind the link between frailty and cognitive impairment
J Nutr Health Aging
Increasing use of cognitive measures in the operational definition of frailty—a systematic review
Ageing Res Rev
Sex hormones and male health: effects on components of the frailty syndrome
Trends Endocrinol Metab
Association between IL-8 cytokine and cognitive performance in an elderly general population—the MEMO-Study
Neurobiol Aging
Cited by (40)
Relationship Between Cognitive Frailty and Mortality in Older Adults: A Systematic Review and Meta-Analysis
2023, Journal of the American Medical Directors AssociationCognitive frailty among community-dwelling rural elderly population of West Bengal in India
2022, Asian Journal of PsychiatryCitation Excerpt :Furthermore, if participants reported higher score in HRQoL to lower score in HRQoL, the chances of being frail compared with robust were expected to decrease (RRR = 0.93; 95% CI: 0.91−0.96, P < 0.01). The community-based prevalence of cognitive frailty as obtained from this study was 21.8%, which is comparable with the findings from the USA (12.7%) (Downer et al., 2019), Spain (22.6%) (Esteban-Cornejo et al., 2019) and Canada (37.3%) (Montero-Odasso et al., 2016). Prevalence is noticeably higher in the current community setting.
Prevalence of cognitive frailty among community-dwelling older adults: A systematic review and meta-analysis
2022, International Journal of Nursing StudiesCitation Excerpt :One study was excluded because the evaluation tools did not meet the criteria. Finally, a total of 24 studies were included in the systematic review and meta-analysis (Aliberti et al., 2019; Zhao et al., 2020; Xie et al., 2020; Tsutsumimoto et al., 2020; Ruan et al., 2020; Ma et al., 2020; Li et al., 2020; Ge et al., 2020; Rivan et al., 2019; Moon et al., 2019; Kim et al., 2019; Esteban-Cornejo et al., 2019; Wanaratna et al., 2019; Liu et al., 2018; Lee et al., 2018; Hao et al., 2018; St John et al., 2017; Solfrizzi et al., 2017; Roppolo et al., 2017; Ma et al., 2017; Montero-Odasso et al., 2016; Woo et al., 2015; Shimada et al., 2013; Monteiro Macuco et al., 2012). The details of the screening process are shown in Fig. 1.
Does physical activity protect older persons with frailty and cognitive impairment from excess all-cause mortality?
2021, Archives of Gerontology and GeriatricsCitation Excerpt :In the present study, we failed to find a beneficial effect of physical activity on mortality risk among participants with coexisting frailty/pre-frailty and cognitive impairment. In contrast to our results, Esteban-Cornejo and colleagues analyzed data from 3677 noninstitutionalized individuals in Spain and found that being active was associated with a relative reduction in mortality risk of 36% in participants with frailty/pre-frailty combined with cognitive impairment (Esteban-Cornejo et al., 2019). These discrepancies may be due to differences in study population and study duration.
Motoric cognitive risk syndrome, physio-cognitive decline syndrome, cognitive frailty and reversibility with dual-task exercise
2021, Experimental GerontologyCitation Excerpt :Similar to cognition, physical activity and/or multicomponent interventions have been shown to reverse frailty, improve physical performance and quality of life in pre-frail and frail community-dwelling older adults (Yu et al., 2020; Haider et al., 2019). Multiple benefits of physical activity have also been shown in CF including mortality reduction and improvement of function and/or cognition (Liu et al., 2018; Esteban-Cornejo et al., 2019). HAPPY exercises are conducted in the community setting where up to two thirds of the exercises during the 60 min are made up of dual-task exercises.
Facilitators and Barriers to Attendance in a Nursing Home Exercise Program
2021, Journal of the American Medical Directors AssociationCitation Excerpt :Understanding the effect of nursing home quality on an exercise program such as Bingocize could lead to targeted improvement in exercise and social programming in nursing homes of poorer quality. A longitudinal study of older adults living in the community revealed that persons who were physically active, even with mild cognitive impairment, experienced reduced mortality compared with those who were inactive.20 The taskforce of the International Association of Gerontology and Geriatrics—Global Aging Research Network (IAGG-GARN) and the IAGG European Region Clinical Section made recommendations for Physical Activity and Exercise for Older adults Living in Long-term Care Facilities and stated that the exercise-related objective for long-term care facility (LTCF) residents focus on functional ability and improvements in quality of life.21
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.