Skip to main content
SpringerLink
Log in

Association between Cognitive Frailty and Adverse Outcomes among Older Adults: A Meta-Analysis

  • Review
  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

This systematic review and meta-analysis aimed to pool the effect size of the association between cognitive frailty and adverse outcomes (e.g., falls, disability, and hospitalization) among older adults.

Design

Systematic review and meta-analysis.

Methods

PubMed, ScienceDirect, and Embase were searched from their respective inceptions to June 1, 2022. We extracted prospective cohort studies that reported the association between cognitive frailty and adverse outcomes. Random or fixed-effects models based on heterogeneity were used to pool the effect sizes of independent associations of cognitive frailty, frailty only, and cognitive impairment only with each adverse outcome.

Results

Fifteen studies involving 49,122 older adults were included in the meta-analysis. Older adults with cognitive frailty had higher odds ratios (OR) for falls (1.82, 95% confidence interval [CI]: 1.29–2.58), disability (3.17, 95%CI: 2.24–4.48), and hospitalization (1.78, 95%CI: 1.48–2.14) compared with those without frailty and cognitive impairment. Older adults with frailty only demonstrated a high risk for falls (pooled OR 1.76, 95%CI: 1.25–2.48), disability (pooled OR 1.82, 95%CI: 1.43–2.33), and hospitalization (pooled OR 1.64, 95% CI: 1.45–1.85). The influence of cognitive impairment only on adverse outcomes was lower compared with cognitive frailty or frailty. Subgroup analyses showed that those with cognitive frailty (defined by the frailty phenotype plus Mini-Mental State Examination) were at greater risk for developing adverse outcomes.

Conclusion

Our findings indicate that cognitive frailty is an independent risk factor for adverse outcomes (e.g., falls, disability, and hospitalization). Early screening and comprehensive intervention may improve cognitive frailty and reduce the risk for adverse outcomes among older adults.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Vetrano DL, Foebel AD, Marengoni A, et al. Chronic diseases and geriatric syndromes: The different weight of comorbidity. European journal of internal medicine 2016; 27: 62–7. doi: https://doi.org/10.1016/j.ejim.2015.10.025

    Article  PubMed  Google Scholar 

  2. Rohrmann S. Epidemiology of Frailty in Older People. Advances in experimental medicine and biology 2020; 1216: 21–27. doi: https://doi.org/10.1007/978-3-030-33330-0_3

    Article  PubMed  Google Scholar 

  3. Pais R, Ruano L, Moreira C, Carvalho OP, Barros H. Prevalence and incidence of cognitive impairment in an elder Portuguese population (65–85 years old). BMC geriatrics 2020; 20: 470. doi: https://doi.org/10.1186/s12877-020-01863-7

    Article  PubMed  PubMed Central  Google Scholar 

  4. O’Caoimh R, Sezgin D, O’Donovan MR, et al. Prevalence of frailty in 62 countries across the world: a systematic review and meta-analysis of population-level studies. Age Ageing 2021; 50: 96–104. doi: https://doi.org/10.1093/ageing/afaa219

    Article  PubMed  Google Scholar 

  5. Gómez Jiménez E, Avendaño Céspedes A, Cortés Zamora EB, García Molina R, Abizanda P. [Frailty prevalence in hospitalized older adults. A systematic review.]. Revista espanola de salud publica 2021; 95

  6. Veronese N, Custodero C, Cella A, et al. Prevalence of multidimensional frailty and pre-frailty in older people in different settings: A systematic review and meta-analysis. Ageing research reviews 2021; 72: 101498. doi: https://doi.org/10.1016/j.arr.2021.101498

    Article  PubMed  Google Scholar 

  7. Zhang X, Dou Q, Zhang W, et al. Frailty as a Predictor of All-Cause Mortality Among Older Nursing Home Residents: A Systematic Review and Meta-analysis. Journal of the American Medical Directors Association 2019; 20: 657–63.e4. doi: https://doi.org/10.1016/j.jamda.2018.11.018

    Article  PubMed  CAS  Google Scholar 

  8. Lan X, Li H, Wang Z, Chen Y. Frailty as a predictor of future falls in hospitalized patients: A systematic review and meta-analysis. Geriatric nursing (New York, NY) 2020; 41: 69–74. doi: https://doi.org/10.1016/j.gerinurse.2019.01.004

    Article  Google Scholar 

  9. Chang SF, Lin HC, Cheng CL. The Relationship of Frailty and Hospitalization Among Older People: Evidence From a Meta-Analysis. Journal of nursing scholarship: an official publication of Sigma Theta Tau International Honor Society of Nursing 2018; 50: 383–91. doi: https://doi.org/10.1111/jnu.12397

    Article  Google Scholar 

  10. Muir SW, Gopaul K, Montero Odasso MM. The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. Age and Ageing 2012; 41: 299–308. doi: https://doi.org/10.1093/ageing/afs012 %J Age and Ageing

    Article  PubMed  Google Scholar 

  11. Bae JB, Han JW, Kwak KP, et al. Impact of Mild Cognitive Impairment on Mortality and Cause of Death in the Elderly. Journal of Alzheimer’s disease: JAD 2018; 64: 607–16. doi: https://doi.org/10.3233/jad-171182

    Article  PubMed  Google Scholar 

  12. Shimada H, Makizako H, Doi T, Tsutsumimoto K, Lee S, Suzuki T. Cognitive Impairment and Disability in Older Japanese Adults. PloS one 2016; 11: e0158720. doi: https://doi.org/10.1371/journal.pone.0158720

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Stites SD, Harkins K, Rubright JD, Karlawish J. Relationships Between Cognitive Complaints and Quality of Life in Older Adults With Mild Cognitive Impairment, Mild Alzheimer Disease Dementia, and Normal Cognition. Alzheimer Dis Assoc Disord 2018; 32: 276–83. doi: https://doi.org/10.1097/WAD.0000000000000262

    Article  PubMed  PubMed Central  Google Scholar 

  14. Samuel R, McLachlan CS, Mahadevan U, Isaac V. Cognitive impairment and reduced quality of life among old-age groups in Southern Urban India: home-based community residents, free and paid old-age home residents. QJM: An International Journal of Medicine 2016; 109: 653–59. doi: https://doi.org/10.1093/qjmed/hcw040 %J QJM: An International Journal of Medicine

    Article  CAS  Google Scholar 

  15. Doi T, Makizako H, Tsutsumimoto K, et al. Combined effects of mild cognitive impairment and slow gait on risk of dementia. Experimental gerontology 2018; 110: 146–50. doi: https://doi.org/10.1016/j.exger.2018.06.002

    Article  PubMed  Google Scholar 

  16. Feng L, Zin Nyunt MS, Gao Q, Feng L, Yap KB, Ng TP. Cognitive Frailty and Adverse Health Outcomes: Findings From the Singapore Longitudinal Ageing Studies (SLAS). Journal of the American Medical Directors Association 2017; 18: 252–58. doi: https://doi.org/10.1016/j.jamda.2016.09.015

    Article  PubMed  Google Scholar 

  17. Yu R, Morley JE, Kwok T, Leung J, Cheung O, Woo J. The Effects of Combinations of Cognitive Impairment and Pre-frailty on Adverse Outcomes from a Prospective Community-Based Cohort Study of Older Chinese People. Frontiers in medicine 2018; 5: 50. doi: https://doi.org/10.3389/fmed.2018.00050

    Article  PubMed  PubMed Central  Google Scholar 

  18. RECIPROCAL RELATIONSHIPS BETWEEN FRAILTY AND COGNITION: LONGITUDINAL RESEARCH USING SHARE DATA. The Gerontologist 2015; 55: 569–70. doi: https://doi.org/10.1093/geront/gnv281.03 %J The Gerontologist

  19. Kelaiditi E, Cesari M, Canevelli M, et al. Cognitive frailty: rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group. The journal of nutrition, health & aging 2013; 17: 726–34. doi: https://doi.org/10.1007/s12603-013-0367-2

    Article  CAS  Google Scholar 

  20. Zhang XM, Jiao J, Zhu C, et al. Cognitive Frailty and 30-Day Mortality in a National Cohort of Older Chinese Inpatients. Clinical interventions in aging 2021; 16: 389–401. doi: https://doi.org/10.2147/cia.S294106

    Article  PubMed  PubMed Central  Google Scholar 

  21. Rivan NFM, Singh DKA, Shahar S, et al. Cognitive frailty is a robust predictor of falls, injuries, and disability among community-dwelling older adults. BMC geriatrics 2021; 21: 593. doi: https://doi.org/10.1186/s12877-021-02525-y

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ma Y, Li X, Pan Y, et al. Cognitive frailty predicting death and disability in Chinese elderly. Neurological research 2021; 43: 815–22. doi: https://doi.org/10.1080/01616412.2021.1939235

    Article  PubMed  CAS  Google Scholar 

  23. Chen JH, Shih HS, Tu J, et al. A Longitudinal Study on the Association of Interrelated Factors Among Frailty Dimensions, Cognitive Domains, Cognitive Frailty, and All-Cause Mortality. Journal of Alzheimer’s disease: JAD 2021; 84: 1795–809. doi: https://doi.org/10.3233/jad-215111

    Article  PubMed  CAS  Google Scholar 

  24. Bu Z, Huang A, Xue M, Li Q, Bai Y, Xu G. Cognitive frailty as a predictor of adverse outcomes among older adults: A systematic review and meta-analysis. Brain and behavior 2021; 11: e01926. doi: https://doi.org/10.1002/brb3.1926

    Article  PubMed  Google Scholar 

  25. Vatanabe IP, Pedroso RV, Teles RHG, et al. A systematic review and meta-analysis on cognitive frailty in community-dwelling older adults: risk and associated factors. Aging & mental health 2022; 26: 464–76. doi: https://doi.org/10.1080/13607863.2021.1884844

    Article  Google Scholar 

  26. Zhang XM, Yuan L, Quo N, et al. Cognitive Frailty and Falls in a National Cohort of Older Chinese Inpatients. Journal of Nutrition, Health and Aging 2021; 25: 993–98. doi: https://doi.org/10.1007/s12603-021-1670-y

    Article  Google Scholar 

  27. Wang W, Si H, Yu R, et al. Effects of reversible cognitive frailty on disability, quality of life, depression, and hospitalization: a prospective cohort study. Aging & mental health 2021: 1–8. doi: https://doi.org/10.1080/13607863.2021.2011835

  28. Wang J, Kong D, Yu F, Conwell Y, Dong X. Cognitive deficit, physical frailty, hospitalization and emergency department visits in later life. Aging & mental health 2021; 25: 521–27. doi: https://doi.org/10.1080/13607863.2019.1699015

    Article  Google Scholar 

  29. Ma Y, Li X, Pan Y, et al. Cognitive frailty and falls in Chinese elderly people: a population-based longitudinal study. European journal of neurology 2021; 28: 381–88. doi: https://doi.org/10.1111/ene.14572

    Article  PubMed  CAS  Google Scholar 

  30. Chen C, Park J, Wu C, et al. Cognitive frailty in relation to adverse health outcomes independent of multimorbidity: results from the China health and retirement longitudinal study. Aging 2020; 12: 23129–45. doi: https://doi.org/10.18632/aging.104078

    PubMed  PubMed Central  Google Scholar 

  31. Solfrizzi V, Scafato E, Lozupone M, et al. Additive Role of a Potentially Reversible Cognitive Frailty Model and Inflammatory State on the Risk of Disability: The Italian Longitudinal Study on Aging. The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 2017; 25: 1236–48. doi: https://doi.org/10.1016/j.jagp.2017.05.018

    Article  Google Scholar 

  32. Rumbold AR, Moore VM, Whitrow MJ, et al. The impact of specific fertility treatments on cognitive development in childhood and adolescence: a systematic review. Human reproduction (Oxford, England) 2017; 32: 1489–507. doi: https://doi.org/10.1093/humrep/dex085

    Article  Google Scholar 

  33. Melsen WG, Bootsma MCJ, Rovers MM, Bonten MJM. The effects of clinical and statistical heterogeneity on the predictive values of results from metaanalyses. Clinical Microbiology and Infection 2014; 20: 123–29. doi: https://doi.org/10.1111/1469-0691.12494

    Article  PubMed  CAS  Google Scholar 

  34. Avila-Funes JA, Amieva H, Barberger-Gateau P, et al. Cognitive impairment improves the predictive validity of the phenotype of frailty for adverse health outcomes: the three-city study. Journal of the American Geriatrics Society 2009; 57: 453–61. doi: https://doi.org/10.1111/j.1532-5415.2008.02136.x

    Article  PubMed  Google Scholar 

  35. Brigola AG, Ottaviani AC, Alexandre TDS, Luchesi BM, Pavarini SCI. Cumulative effects of cognitive impairment and frailty on functional decline, falls and hospitalization: A four-year follow-up study with older adults. Archives of gerontology and geriatrics 2020; 87: 104005. doi: https://doi.org/10.1016/j.archger.2019.104005

    Article  PubMed  Google Scholar 

  36. Tsutsumimoto K, Doi T, Nakakubo S, et al. Cognitive Frailty as a Risk Factor for Incident Disability During Late Life: A 24-Month Follow-Up Longitudinal Study. Journal of Nutrition, Health and Aging 2020; 24: 494–99. doi: https://doi.org/10.1007/s12603-020-1365-9

    Article  CAS  Google Scholar 

  37. Zhao D, Li J, Fu P, et al. What Role Does Activity Engagement Play in the Association between Cognitive Frailty and Falls among Older Adults? Evidence from Rural Shandong, China. Gerontology 2020; 66: 593–602. doi: https://doi.org/10.1159/000510639

    Article  PubMed  Google Scholar 

  38. Ge ML, Simonsick EM, Dong BR, Kasper JD, Xue QL. Frailty, With or Without Cognitive Impairment, Is a Strong Predictor of Recurrent Falls in a US Population-Representative Sample of Older Adults. The journals of gerontology Series A, Biological sciences and medical sciences 2021; 76: e354–e60. doi: https://doi.org/10.1093/gerona/glab083

    Article  PubMed  PubMed Central  Google Scholar 

  39. Zheng L, Li G, Gao D, et al. Cognitive frailty as a predictor of dementia among older adults: A systematic review and meta-analysis. Archives of gerontology and geriatrics 2020; 87: 103997. doi: https://doi.org/10.1016/j.archger.2019.103997

    Article  PubMed  Google Scholar 

  40. Vatanabe IP, Pedroso RV, Teles RHG, et al. A systematic review and meta-analysis on cognitive frailty in community-dwelling older adults: risk and associated factors. Aging & mental health 2021: 1–13. doi: https://doi.org/10.1080/13607863.2021.1884844

  41. Hartholt KA, Lee R, Burns ER, van Beeck EF. Mortality From Falls Among US Adults Aged 75 Years or Older, 2000–2016. Jama 2019; 321: 2131–33. doi: https://doi.org/10.1001/jama.2019.4185

    Article  PubMed  PubMed Central  Google Scholar 

  42. Forman-Hoffman VL, Ault KL, Anderson WL, et al. Disability status, mortality, and leading causes of death in the United States community population. Medical care 2015; 53: 346–54. doi: https://doi.org/10.1097/mlr.0000000000000321

    Article  PubMed  PubMed Central  Google Scholar 

  43. Lee YY, Chen CL, Lee IC, Lee IC, Chen NC. History of Falls, Dementia, Lower Education Levels, Mobility Limitations, and Aging Are Risk Factors for Falls among the Community-Dwelling Elderly: A Cohort Study. International journal of environmental research and public health 2021; 18 doi: https://doi.org/10.3390/ijerph18179356

  44. Avan A, Hachinski V. Stroke and dementia, leading causes of neurological disability and death, potential for prevention. Alzheimer’s & dementia: the journal of the Alzheimer’s Association 2021; 17: 1072–76. doi: https://doi.org/10.1002/alz.12340

    Article  Google Scholar 

  45. Kojima G. Frailty as a Predictor of Future Falls Among Community-Dwelling Older People: A Systematic Review and Meta-Analysis. Journal of the American Medical Directors Association 2015; 16: 1027–33. doi: https://doi.org/10.1016/j.jamda.2015.06.018

    Article  PubMed  Google Scholar 

  46. Makizako H, Shimada H, Doi T, Tsutsumimoto K, Suzuki T. Impact of physical frailty on disability in community-dwelling older adults: a prospective cohort study. BMJ open 2015; 5: e008462. doi: https://doi.org/10.1136/bmjopen-2015-008462

    Article  PubMed  PubMed Central  Google Scholar 

  47. Liu HX, Ding G, Yu WJ, et al. Association between frailty and incident risk of disability in community-dwelling elder people: evidence from a meta-analysis. Public health 2019; 175: 90–100. doi: https://doi.org/10.1016/j.puhe.2019.06.010

    Article  PubMed  CAS  Google Scholar 

  48. Uchmanowicz I, Lee CS, Vitale C, et al. Frailty and the risk of all-cause mortality and hospitalization in chronic heart failure: a meta-analysis. ESC heart failure 2020; 7: 3427–37. doi: https://doi.org/10.1002/ehf2.12827

    Article  PubMed Central  Google Scholar 

  49. Fogg C, Meredith P, Culliford D, Bridges J, Spice C, Griffiths P. Cognitive impairment is independently associated with mortality, extended hospital stays and early readmission of older people with emergency hospital admissions: A retrospective cohort study. International Journal of Nursing Studies 2019; 96: 1–8. doi: https://doi.org/10.1016/j.ijnurstu.2019.02.005

    Article  PubMed  Google Scholar 

  50. Kewcharoen J, Trongtorsak A, Kanitsoraphan C, et al. Cognitive impairment and 30-day rehospitalization rate in patients with acute heart failure: A systematic review and meta-analysis. Indian Heart Journal 2019; 71: 52–59. doi: https://doi.org/10.1016/j.ihj.2018.12.006

    Article  PubMed  PubMed Central  Google Scholar 

  51. Qiu Y, Li G, Wang X, et al. Prevalence of cognitive frailty among community-dwelling older adults: A systematic review and meta-analysis. Int J Nurs Stud 2022; 125: 104112. doi: https://doi.org/10.1016/j.ijnurstu.2021.104112

    Article  PubMed  Google Scholar 

  52. Yoon DH, Lee JY, Song W. Effects of Resistance Exercise Training on Cognitive Function and Physical Performance in Cognitive Frailty: A Randomized Controlled Trial. The journal of nutrition, health & aging 2018; 22: 944–51. doi: https://doi.org/10.1007/s12603-018-1090-9

    Article  CAS  Google Scholar 

  53. Liu Z, Hsu FC, Trombetti A, et al. Effect of 24-month physical activity on cognitive frailty and the role of inflammation: the LIFE randomized clinical trial. BMC medicine 2018; 16: 185. doi: https://doi.org/10.1186/s12916-018-1174-8

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  54. Murukesu RR, Singh DKA, Shahar S, Subramaniam P. A Multi-Domain Intervention Protocol for the Potential Reversal of Cognitive Frailty: “WE-RISE” Randomized Controlled Trial. Frontiers in public health 2020; 8: 471. doi: https://doi.org/10.3389/fpubh.2020.00471

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgement

We thank Audrey Holmes, MA, from Liwen Bianji (Edanz) (https://www.liwenbianji.cn/) for editing the English text of a draft of this manuscript.

Funding

Funding: This work was supported by the Peking Union Medical College Hospital Research Fund (Grant number: ZC201900516).

Author information

Authors and Affiliations

  1. Department of Nursing, Chinese Academy of Medical Sciences-Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China

    Xiao Ming Zhang, Xin Juan Wu, J. Cao & J. Jiao

  2. Department of Clinical Nutrition, Department of Health Medicine, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, China

    W. Chen

Authors
  1. Xiao Ming Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xin Juan Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Jiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Xiao Ming Zhang or Xin Juan Wu.

Ethics declarations

Declaration of competing interests: No competing interests existed among our authors.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, X.M., Wu, X.J., Cao, J. et al. Association between Cognitive Frailty and Adverse Outcomes among Older Adults: A Meta-Analysis. J Nutr Health Aging 26, 817–825 (2022). https://doi.org/10.1007/s12603-022-1833-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-022-1833-5

Keywords

Search

Navigation