Cognitive Frailty And Risk Of Functional Disability In Older Japanese Adults: A 4-Year Prospective Study

Abstract Background Cognitive frailty is a newly proposed clinical entity, referring to concurrent cognitive impairment and physical frailty in the absence of dementia. The clinical significance of cognitive frailty remains poorly understood. We aimed to investigate the association between cognitive frailty and functional disability in older adults. Methods A total of 1,644 non-demented older adults aged ≥65 years (mean age: 73 ± 6 years; men: 41.8%) and without functional disability at baseline were followed-up for 4 years. Cognitive frailty was defined as the presence of both physical frailty (based on the modified Cardiovascular Health Study criteria) and cognitive impairment (Mini-Mental State Examination score of <24 points). Functional disability was identified using the database of Japan’s Long-term Care Insurance System. Association between cognitive frailty and functional disability was assessed by using the Cox proportional hazard models. Results During the follow-up, 152 participants were identified as being functionally disabled. There was a significant interaction between physical frailty and cognitive impairment on the development of functional disability (P <0.1). Compared with being robust both physically and cognitively, the hazard ratio (95% confidence interval) of functional disability was 8.40 (4.05-17.42) for cognitively frailty, after adjustment for age, sex, education, living alone, smoking, drinking, number of comorbidities (hypertension, stroke, chronic heart disease, diabetes, chronic kidney disease, poor hearing, poor vision, osteoarthritis or rheumatism, minor trauma fracture, or cancer). Conclusion Cognitive frailty was associated with an increased risk of functional disability in community-dwelling older adults. Cognitive frailty could be an underrecognized risk factor for functional disability.

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Heterogeneous Influence of Frailty Phenotypes in Age-Related Hearing Loss and Tinnitus in Chinese Older Adults: An Explorative Study

Frontiers in Psychology ◽

10.3389/fpsyg.2020.617610 ◽

2021 ◽

Vol 11 ◽

Author(s):

Qingwei Ruan ◽

Jie Chen ◽

Ruxin Zhang ◽

Weibin Zhang ◽

Jian Ruan ◽

...

Keyword(s):

Older Adults ◽

Hearing Loss ◽

Cognitive Impairment ◽

Cognitive Decline ◽

Community Dwelling ◽

Lower Probability ◽

Physical Frailty ◽

Frailty Phenotype ◽

Cognitive Frailty ◽

Age Related

BackgroundFried physical frailty, with mobility frailty and non-motor frailty phenotypes, is a heterogeneous syndrome. The coexistence of the two phenotypes and cognitive impairment is referred to as cognitive frailty (CF). It remains unknown whether frailty phenotype has a different association with hearing loss (HL) and tinnitus.MethodsOf the 5,328 community-dwelling older adults, 429 participants aged ≥58 years were enrolled in the study. The participants were divided into robust, mobility, and non-mobility frailty, mobility and non-mobility CF (subdivided into reversible and potentially reversible CF, RCF, and PRCF), and cognitive decline [subdivided into mild cognitive impairment (MCI) and pre-MCI] groups. The severity and presentations of HL and/or tinnitus were used as dependent variables in the multivariate logistic or nominal regression analyses with forward elimination adjusted for frailty phenotype stratifications and other covariates.ResultsPatients with physical frailty (mobility frailty) or who are robust were found to have lower probability of developing severe HL and tinnitus, and presented HL and/or tinnitus than those with only cognitive decline, or CF. Patients with RCF and non-mobility RCF had higher probability with less HL and tinnitus, and the presentation of HL and/or tinnitus than those with PRCF and mobility RCF. Other confounders, age, cognitive and social function, cardiovascular disease, depression, and body mass index, independently mediated the severity of HL and tinnitus, and presented HL and/or tinnitus.ConclusionFrailty phenotypes have divergent association with HL and tinnitus. Further research is required to understand the differential mechanisms and the personalized intervention of HL and tinnitus.Clinical Trial RegistrationClinicalTrials.gov identifier, NCT2017K020.

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ASSOCIATION OF SENSORY AND COGNITIVE IMPAIRMENT WITH HEALTHCARE UTILIZATION AND COST IN MEDICARE BENEFICIARIES

Innovation in Aging ◽

10.1093/geroni/igz038.170 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S44-S44

Author(s):

William Deardorff ◽

Phillip liu ◽

Richard Sloane ◽

Courtney Van Houtven ◽

Susan N Hastings ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Healthcare Cost ◽

Functional Disability ◽

Hospital Admissions ◽

Adverse Outcomes ◽

Community Dwelling ◽

Vision Impairment ◽

Increased Risk ◽

Sensory Impairments

Abstract The combination of sensory and cognitive impairment is increasingly prevalent among older adults and may be an important driver of healthcare cost due to functional disability and reduced self-care. This presentation focuses on the relationship between hearing and/or vision impairment and cognitive impairment with hospital admissions and healthcare cost using data from the Medicare Current Beneficiary Survey, a nationally representative sample of community-dwelling adults. We show that the presence of sensory impairment is associated with increased risk of hospitalization regardless of dementia status. In adjusted models, annual total healthcare costs were generally higher among those with sensory impairments compared to those without sensory impairments. We will also discuss work related to the development of a prognostic model that provides estimates of hospitalization risk among older adults with self-reported hearing and/or vision impairment. This model may help inform allocation of health care resources to those at highest risk for adverse outcomes.

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Cognitive Frailty Predicts Incident Dementia among Community-Dwelling Older People

Journal of Clinical Medicine ◽

10.3390/jcm7090250 ◽

2018 ◽

Vol 7 (9) ◽

pp. 250 ◽

Cited By ~ 21

Author(s):

Hiroyuki Shimada ◽

Takehiko Doi ◽

Sangyoon Lee ◽

Hyuma Makizako ◽

Liang-Kung Chen ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Significant Risk ◽

Word List ◽

Community Dwelling ◽

Prevalence Rates ◽

Physical Frailty ◽

Cognitive Frailty ◽

Primary Screening ◽

Incident Dementia

Cognitive frailty, defined as the presence of both frailty and cognitive impairment, is a risk factor for adverse events in older adults. However, prevalence rates of cognitive frailty are low (1.1–2.5%), so primary screening is unsuitable in community settings. The aim of the study was to examine whether a new definition of cognitive frailty, which was developed for primary screening, is useful to predict incident dementia in community-dwelling older adults. A total of 4570 older adults participated in the study (2326 women; average age, 71.9 ± 5.5 years). We defined physical frailty as the presence of ≥1 of the following symptoms: slow walking speed and muscle weakness. Cognitive impairment was defined as ≥1 symptom of cognitive impairment, indicated by an age- and education-adjusted score that was ≥1.5 standard deviations below the reference threshold in word list memory, attention, executive function, and processing speed tests. Cognitive frailty was defined as comorbid physical frailty and cognitive impairment. The incidence of dementia was determined using data collected by the Japanese Health Insurance System over 36 months. The prevalence rates of physical frailty, cognitive impairment, and cognitive frailty were 17.5%, 15.3%, and 9.8%, respectively. Cognitive impairment (hazard ratio [HR]: 2.06, 95% confidence interval [95% CI]: 1.41–3.02) and cognitive frailty (HR: 3.43, 95% CI: 2.37–4.97) were found to be significant risk factors for dementia. However, the association between dementia and physical frailty was not significant (HR: 1.13, 95% CI: 0.76–1.69). Individuals with comorbid physical frailty and cognitive impairment could have a higher risk of dementia than healthy older adults or older adults with either physical frailty or cognitive impairment alone.

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Incidence and Predictors of Cognitive Frailty Among Older Adults: A Community-based Longitudinal Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17051547 ◽

2020 ◽

Vol 17 (5) ◽

pp. 1547 ◽

Cited By ~ 2

Author(s):

Nurul Fatin Malek Rivan ◽

Suzana Shahar ◽

Nor Fadilah Rajab ◽

Devinder Kaur Ajit Singh ◽

Normah Che Din ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Longitudinal Study ◽

Functional Mobility ◽

Physical Frailty ◽

Community Based ◽

Timed Up And Go ◽

Cognitive Frailty ◽

Increased Risk ◽

Study Results

(1) Background: Cognitive frailty (CF) is the simultaneous presence of physical frailty and cognitive impairment with an increased risk of dementia. Considering that the risk factors of CF are mostly elucidated from cross-sectional studies, we conducted a community-based longitudinal study to determine the incidence and the predictors of CF among Malaysian older adults.; (2) Methods: Out of 490 older adults participating in the Malaysian Towards Useful Aging (TUA) study, 282 were successfully followed-up at five-years for an analysis of the CF incidence. CF was defined as a comorbid physical frailty (>1 Fried criteria) and mild cognitive impairment (Petersen criteria). A comprehensive interview-based questionnaire was administered for sociodemographic information, cognitive function, physical function, dietary intake, psychosocial, and biochemical indices. Univariate analyses were performed for each variable, followed by a regression analysis to identify the predictors of CF that accounted for confounding effects between the studied factors; (3) Results: The incidence rate of CF was 7.1 per 100 person-years. Advancing age (OR=1.12, 95% CI:1.04-1.21, p < 0.05), depression (OR=1.20, 95% CI:1.05-1.37, p < 0.05), decreased processing speed, assessed by a lower digit symbol score (OR=0.67, 95%CI:0.0.56-0.80, p < 0.05), decreased functional mobility measured using Timed-Up-and-Go (TUG) (OR=1.23, 95% CI:1.04-1.46, p < 0.05), low vitamin D intake (OR:0.36, 95% CI:0.14-0.93, p < 0.05) and physical frailty (OR=2.16, 95% CI:1.02-4.58, p < 0.05) were predictors for CF incidence; and (4) Conclusions: Our study results could be used as an initial reference for future studies to formulate effective preventive management and intervention strategies to decelerate CF development among older adults.

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SOCIAL COHESION AFFECTS THE ASSOCIATION BETWEEN FRAILTY AND DISABILITY IN COMMUNITY-DWELLING OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.2876 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S782-S782

Author(s):

Boqin Xie

Keyword(s):

Older Adults ◽

Social Cohesion ◽

Functional Disability ◽

Community Dwelling ◽

Analysis Of Covariance ◽

Health Study ◽

Cardiovascular Health Study ◽

Physical Frailty ◽

The Impact ◽

Community Dwelling Older Adults

Abstract The relationships between physical frailty and perceived neighborhood social cohesion (PNSC) and functional disability among community-dwelling older adults are poorly understood. This study aims to (1) examine the associations of frailty and PNSC with disability; and (2) evaluate low PNSC as a risk factor in the association between frailty and disability. A sample of 1645 older adults using multi-stage sampling method in Shanghai were randomly selected in this cross-sectional study. Frailty operationalized as Cardiovascular Health Study criteria (OR=2.4, 95%CI 1.16-4.96 for pre-frailty; OR=7.28, 95%CI 3.37-15.73 for frailty) and PNSC measured as Neighborhood Cohesion Scale (OR=1.81, 95%CI 1.23-2.67) were independently associated with basic and instrumental activities of daily living disability. A significant interaction of frailty and PNSC on disability (F (2, 66)=4.31, P=.014) was found, using a two-way analysis of covariance (ANCOVA). Compared to robust individuals with high PNSC, pre-frailty with high PNSC was not significantly associated with disability while pre-frailty with low PNSC was associated with approximate 4-fold increased prevalence of disability (OR=3.87, 95%CI 1.46-10.24, p=.006). Frailty with high PNSC was associated with higher likelihood of disability (OR=6.47, 95%CI 2.35-17.87) and frail individuals with low PNSC stood out with 10-fold increased prevalence of disability (OR=9.94, 95%CI 3.50-28.26). All analyses were controlled for demographical and clinical covariates. Our results suggest high level of social cohesion serves as a buffer against the impact of physical frailty on functional disability. These findings notably imply to the development of interventions for older frail adults from the neighborhood perspective.

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Association between Physical Frailty Subdomains and Oral Frailty in Community-Dwelling Older Adults

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18062931 ◽

2021 ◽

Vol 18 (6) ◽

pp. 2931

Author(s):

Ryo Komatsu ◽

Koutatsu Nagai ◽

Yoko Hasegawa ◽

Kazuki Okuda ◽

Yuto Okinaka ◽

...

Keyword(s):

Older Adults ◽

Gait Speed ◽

Community Dwelling ◽

Health Study ◽

Cardiovascular Health Study ◽

Physical Frailty ◽

Cross Sectional ◽

Important Indicator ◽

Community Dwelling Older Adults ◽

Oral Frailty

This cross-sectional study aimed to demonstrate the association between physical frailty subdomains and oral frailty. This study involved community-dwelling older adults (aged ≥65 years). Physical frailty was assessed with the Japanese version of the Cardiovascular Health Study criteria. Oral frailty was defined as limitations in at least three of six domains. Logistic regression analysis was used to analyze the association between physical frailty risk and oral frailty. In addition, we examined the association between physical frailty subdomains (gait speed, grip strength, exhaustion, low physical activity, and weight loss) and oral frailty. A total of 380 participants were recruited for this study. Overall, 18% and 14% of the participants were at risk of physical frailty and had oral frailty, respectively. Physical frailty risk (odds ratio (OR) = 2.40, 95% confidence interval (CI): 1.22–4.75, p = 0.012) was associated with oral frailty in multivariate analysis. In secondary analysis, among physical frailty subdomains, gait speed (OR = 0.85, 95% CI: 0.73–0.97, p = 0.019) was associated with oral frailty. The present findings suggest that physical frailty is closely related to oral frailty. Among physical frailty subdomains, decreased gait speed in particular is an important indicator related to the development of oral frailty.

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Prospective Associations of Physical Frailty With Future Falls and Fear of Falling: A 48-Month Cohort Study

Physical Therapy ◽

10.1093/ptj/pzab059 ◽

2021 ◽

Author(s):

K Makino ◽

S Lee ◽

S Bae ◽

I Chiba ◽

K Harada ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

Fear Of Falling ◽

Community Dwelling ◽

Cardiovascular Health Study ◽

Physical Frailty ◽

Frailty Status ◽

Community Dwelling Older Adults ◽

The Relationship

Abstract Objective The present study aimed to examine the prospective associations of physical frailty with future falls and fear of falling (FOF) among community-dwelling older adults. Methods A prospective cohort study with a 48-month follow-up was conducted in a Japanese community. Participants were 2469 community-dwelling older adults aged 65 years or older who completed baseline and follow-up assessments at intervals of 48±2 months. Primary outcomes were recent falls (defined as at least one fall within the past year) and FOF (determined by response to “Are you afraid of falling?”) at follow-up survey. Physical frailty, operationalized by the frailty phenotype (slowness, weakness, exhaustion, weight loss, and low activity) based on the criteria of the Japanese version of the Cardiovascular Health Study (J-CHS), was also assessed as a predictor of future falls and FOF. Results Multivariate logistic regression showed that pre-frailty or frailty increase the risk of not only future falls (OR: 1.57; 95%CI = 1.20-2.05) but also FOF (OR: 1.33; 95%CI = 1.05-1.69). In addition, the relationship between baseline frailty status and future falls remained significant after adjusting for baseline FOF (OR: 1.55; 95%CI = 1.19-2.02), and the relationship between baseline frailty status and future FOF also remained significant after adjusting for baseline falls (OR: 1.32; 95%CI = 1.04-1.68). Conclusions Frailty status may predict future falls and FOF among community-dwelling older adults. Strategies to prevent frailty may be beneficial to prevent not only future falls but also future FOF in a community setting. Impact Falls and FOF have a close relationship but a different clinical meaning. Older adults with physical frailty may require monitoring as high-risk not only for falls but also for FOF.

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Exploring the Association between Multimorbidity and Cognitive Impairment in Older Adults Living in the Community: A Review of the Literature

Home Health Care Management & Practice ◽

10.1177/10848223211030468 ◽

2021 ◽

pp. 108482232110304

Author(s):

Grace F. Wittenberg ◽

Michelle A. McKay ◽

Melissa O’Connor

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Assessment Tool ◽

Adult Population ◽

Home Health ◽

Adverse Outcomes ◽

Community Dwelling ◽

Cognitive Screening ◽

Review Of The Literature ◽

Increased Risk

Two-thirds of older adults have multimorbidity (MM), or co-occurrence of two or more medical conditions. Mild cognitive impairment (CI) is found in almost 20% of older adults and can lead to further cognitive decline and increased mortality. Older adults with MM are the primary users of home health care services and are at high risk for CI development; however, there is no validated cognitive screening tool used to assess the level of CI in home health users. Given the prevalence of MM and CI in the home health setting, we conducted a review of the literature to understand this association. Due to the absence of literature on CI in home health users, the review focused on the association of MM and CI in community-dwelling older adults. Search terms included home health, older adults, cognitive impairment, and multimorbidity and were applied to the databases PubMed, CINAHL, and PsychInfo leading to eight studies eligible for review. Results show CI is associated with MM in older adults of increasing age, among minorities, and in older adults with lower levels of education. Heart disease was the most prevalent disease associated with increased CI. Sleep disorders, hypertension, arthritis, and hyperlipidemia were also significantly associated with increased CI. The presence of MM and CI was associated with increased risk for death among older adults. Further research and attention are needed regarding the use and development of a validated cognitive assessment tool for home health users to decrease adverse outcomes in the older adult population.

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Impact of oral self-care on incident functional disability in elderly Japanese: the Ohsaki Cohort 2006 study

BMJ Open ◽

10.1136/bmjopen-2017-017946 ◽

2017 ◽

Vol 7 (9) ◽

pp. e017946 ◽

Cited By ~ 6

Author(s):

Shino Bando ◽

Yasutake Tomata ◽

Jun Aida ◽

Kemmyo Sugiyama ◽

Yumi Sugawara ◽

...

Keyword(s):

Primary Outcome ◽

Functional Disability ◽

Self Care ◽

Community Dwelling ◽

Tooth Brushing ◽

Term Care ◽

Increased Risk ◽

Long Term Care Insurance ◽

Elderly Japanese

ObjectivesTo assess whether oral self-care (tooth brushing, regular dental visits and use of dentures) affects incident functional disability in elderly individuals with tooth loss.DesignA 5.7-year prospective cohort study.SettingOhsaki City, Japan.Participants12 370 community-dwelling individuals aged 65 years and older.Primary outcome measuresIncident functional disability (new long-term care insurance certification).ResultsThe 5.7-year incidence rate of disability was 18.8%. In comparison with participants who had ≥20 teeth, the HRs (95% CIs) for incident functional disability among participants who had 10–19 and 0–9 teeth were 1.15 (1.01–1.30) and 1.20 (1.07–1.34), respectively (p trend<0.05). However, the corresponding values for those who brushed their teeth ≥2 times per day were not significantly higher in the ‘10–19 teeth’ and ‘0–9 teeth’ groups (HRs (95% CI) 1.05 (0.91–1.21) for participants with 10–19 teeth, and 1.09 (0.96–1.23) for participants with 0–9 teeth), although HRs for those who brushed their teeth <2 times per day were significantly higher (HRs (95% CI) 1.32 (1.12–1.55) for participants with 10–19 teeth, and 1.33 (1.17–1.51) for participants with 0–9 teeth). Such a negating association was not observed for other forms of oral self-care.ConclusionsTooth brushing may partially negate the increased risk of incident functional disability associated with having fewer remaining teeth.

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Day-to-Day Variability and Year-to-Year Reproducibility of Accelerometer-Measured Free-Living Sit-to-Stand Transitions Volume and Intensity among Community-Dwelling Older Adults

Sensors ◽

10.3390/s21186068 ◽

2021 ◽

Vol 21 (18) ◽

pp. 6068

Author(s):

Antti Löppönen ◽

Laura Karavirta ◽

Erja Portegijs ◽

Kaisa Koivunen ◽

Taina Rantanen ◽

...

Keyword(s):

Older Adults ◽

Angular Velocity ◽

Functional Disability ◽

Intraclass Correlation ◽

Living Environment ◽

Community Dwelling ◽

Free Living ◽

Sit To Stand ◽

Increased Risk ◽

Community Dwelling Older Adults

(1) Background: The purpose of this study was to evaluate the day-to-day variability and year-to-year reproducibility of an accelerometer-based algorithm for sit-to-stand (STS) transitions in a free-living environment among community-dwelling older adults. (2) Methods: Free-living thigh-worn accelerometry was recorded for three to seven days in 86 (women n = 55) community-dwelling older adults, on two occasions separated by one year, to evaluate the long-term consistency of free-living behavior. (3) Results: Year-to-year intraclass correlation coefficients (ICC) for the number of STS transitions were 0.79 (95% confidence interval, 0.70–0.86, p < 0.001), for mean angular velocity—0.81 (95% ci, 0.72–0.87, p < 0.001), and maximal angular velocity—0.73 (95% ci, 0.61–0.82, p < 0.001), respectively. Day-to-day ICCs were 0.63–0.72 for number of STS transitions (95% ci, 0.49–0.81, p < 0.001) and for mean angular velocity—0.75–0.80 (95% ci, 0.64–0.87, p < 0.001). Minimum detectable change (MDC) was 20.1 transitions/day for volume, 9.7°/s for mean intensity, and 31.7°/s for maximal intensity. (4) Conclusions: The volume and intensity of STS transitions monitored by a thigh-worn accelerometer and a sit-to-stand transitions algorithm are reproducible from day to day and year to year. The accelerometer can be used to reliably study STS transitions in free-living environments, which could add value to identifying individuals at increased risk for functional disability.

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