Association of cognitive frailty with mortality and hospitalization in older adults: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

FANG Jiamin ¹ , LIANG Hao ² , ZHONG Jintao ¹ , CHEN Muxin ¹ , YANG Xiaomin ¹ , ZHAO Yidi ³ ,  WEI Lin ⁴

1. State Key Laboratory of Traditional Chinese Medicine Syndrome, the Second Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou 510006, P. R. China;
2. Department of Neurology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, P. R. China;
3. College of Nursing, Hunan University of Traditional Chinese Medicine, Changsha 410208, P. R. China;
4. State Key Laboratory of Traditional Chinese Medicine Syndrome, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, P. R. China;

Corresponding author：

WEI Lin, Email: Weilin22@gzucm.edu.cn

Keywords：

Cognitive frailty; Elderly; Mortality; Hospitalization; Meta-analysis

DOI：

10.7507/1672-2531.202310219

Video：

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Objective To systematically review the association of cognitive frailty with mortality and hospitalization in the elderly. Methods The VIP, PubMed, CNKI, WanFang Data, CBM, Embase, Cochrane Library and Web of Science databases were electronically searched to collect cohort studies on the association of cognitive frailty with mortality or hospitalization in the elderly from inception to May, 2023. Two reviewers independently screened the literature, extracted data and assessed risk of bias of the included studies. Meta-analysis was performed by R 4.2.2 software. Results A total of 19 cohort studies involving 63 624 elderly were included. The result of meta-analysis showed that compared with healthy elder, the elder with cognitive frailty had a higher mortality (OR=2.75, 95%CI 2.10 to 3.59, P<0.01) and hospitalization (OR=1.67, 95%CI 1.40 to 2.00, P<0.01). Subgroup analysis showed that cognitive frailty was related to the risk of death in different status of frailty and cognitive function, different assessment tools, different countries of development, different follow-up time and research sites. At the same time, different status of frailty and cognitive function and different levels of development of countries were related to the risk of hospitalization. Conclusion Current evidence shows that cognitive frailty can increase the risk of hospitalization and mortality in the elderly. It is suggested that early screening and intervention of cognitive frailty should be carried out to effectively reduce the risk of adverse consequences, so as to achieve healthy aging.

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2.	Panza F, Lozupone M, Solfrizzi V, et al. Cognitive frailty: a potential target for secondary prevention of dementia. Expert Opin Drug Metab Toxicol, 2017, 13(10): 1023-1027.
3.	Shimada H,Doi T, Lee S, et al. Cognitive frailty predicts incident dementia among community-dwelling older people. J Clin Med, 2018, 7(9): 250.
4.	Tang KF, Teh PL, Lee SWH. Cognitive frailty and functional disability among community-dwelling older adults: a systematic review. Innov Aging, 2023, 7(1): igad005.
5.	Guo X, Pei J, Ma Y, et al. Cognitive frailty as a predictor of future falls in older adults: a systematic review and meta-analysis. J Am Med Dir Assoc, 2023, 24(1): 38-47.
6.	Zou C, Yu Q, Wang C, et al. Association of depression with cognitive frailty: a systematic review and meta-analysis. J Affect Disord, 2023, 320: 133-139.
7.	Lv X, Li W, Ma Y, et al. Cognitive decline and mortality among community-dwelling Chinese older people. BMC Med, 2019, 17(1): 63.
8.	Yu R, Morley JE, Kwok T, et al. The effects of combinations of cognitive impairment and pre-frailty on adverse outcomes from a prospective community-based cohort study of older Chinese people. Front Med (Lausanne), 2018, 5: 50.
9.	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. J Am Geriatr Soc, 2009, 57(3): 453-461.
10.	Feng L, Zin Nyunt MS, Gao Q, et al. Cognitive Frailty and Adverse Health Outcomes: Findings From the Singapore Longitudinal Ageing Studies (SLAS). J Am Med Dir Assoc, 2017, 18(3): 252-258.
11.	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 (Albany NY), 2020, 12(22): 23129-23145.
12.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
13.	王丹, 翟俊霞, 牟振云, 等. Meta分析中的异质性及其处理方法. 中国循证医学杂志, 2009, 9(10): 1115-1118.
14.	Brigola AG, Ottaviani AC, Alexandre TDS, et al. Cumulative effects of cognitive impairment and frailty on functional decline, falls and hospitalization: a four-year follow-up study with older adults. Arch Gerontol Geriatr, 2020, 87: 104005.
15.	Buta B, Friedman AB, Chung SE, et al. The combined effects of physical frailty and cognitive impairment on emergency department- versus direct-admission hospitalizations. BMC Geriatr, 2022, 22(1): 718.
16.	Ong JYQ, Mat S, Kioh SH, et al. Cognitive frailty and 5-year adverse health-related outcomes for the Malaysian elders longitudinal research (MELoR) study. Eur Geriatr Med, 2022, 13(6): 1309-1316.
17.	Wang J, Kong D, Yu F, et al. Cognitive deficit, physical frailty, hospitalization and emergency department visits in later life. Aging Ment Health, 2021, 25(3): 521-527.
18.	Aliberti MJR, Cenzer IS, Smith AK, et al. Assessing risk for adverse outcomes in older adults: the need to include both physical frailty and cognition. J Am Geriatr Soc, 2019, 67(3): 477-483.
19.	Aprahamian I, Suemoto CK, Aliberti MJR, et al. Frailty and cognitive status evaluation can better predict mortality in older adults. Arch Gerontol Geriatr, 2018, 77: 51-56.
20.	Downer B, Al Snih S, Howrey BT, et al. Combined effects of cognitive impairment and pre-frailty on future frailty and death in older Mexican Americans. Aging Ment Health, 2019, 23(10): 1405-1412.
21.	Esteban-Cornejo I, Cabanas-Sánchez V, Higueras-Fresnillo S, et al. Cognitive frailty and mortality in a national cohort of older adults: the role of physical activity. Mayo Clin Proc, 2019, 94(7): 1180-1189.
22.	Lee Y, Kim J, Chon D, et al. The effects of frailty and cognitive impairment on 3-year mortality in older adults. Maturitas, 2018, 107: 50-55.
23.	Ma Y, Li X, Pan Y, et al. Cognitive frailty predicting death and disability in Chinese elderly. Neurol Res, 2021, 43(10): 815-822.
24.	Solfrizzi V, Scafato E, Seripa D, et al. Reversible cognitive frailty, dementia, and all-cause mortality. the Italian longitudinal study on aging. J Am Med Dir Assoc, 2017, 18(1): 81-89.
25.	St John PD, Tyas SL, Griffith LE, et al. The cumulative effect of frailty and cognition on mortality - results of a prospective cohort study. Int Psychogeriatr, 2017, 29(4): 535-543.
26.	Thein FS, Li Y, Nyunt MSZ, et al. Physical frailty and cognitive impairment is associated with diabetes and adversely impact functional status and mortality. Postgrad Med, 2018, 130(6): 561-567.
27.	Wang MC, Li TC, Li CI, et al. Cognitive function and its transitions in predicting all-cause mortality among urban community-dwelling older adults. BMC Psychiatry, 2020, 20(1): 203.
28.	Zhang XM, Jiao J, Zhu C, et al. Cognitive frailty and 30-day mortality in a national cohort of older Chinese inpatients. Clin Interv Aging, 2021, 16: 389-401.
29.	康德英, 洪旗, 刘关键, 等. Meta分析中发表性偏倚的识别与处理. 中国循证医学杂志, 2003, 3(1): 45-49.
30.	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. J Nutr Health Aging, 2013, 17(9): 726-734.
31.	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 Ment Health, 2022, 26(3): 464-476.
32.	Fabrício DM, Chagas MHN, Diniz BS. Frailty and cognitive decline. Transl Res, 2020, 221: 58-64.
33.	Vermeiren S, Vella-Azzopardi R, Beckwée D, et al. Frailty and the prediction of negative health outcomes: a meta-analysis. J Am Med Dir Assoc, 2016, 17(12): 1161-1163.
34.	Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 2001, 56(3): M146-M156.
35.	Fedarko NS. The biology of aging and frailty. Clin Geriatr Med, 2011, 27(1): 27-37.
36.	Smith SG, Jackson SE, Kobayashi LC, et al. Social isolation, health literacy, and mortality risk: findings from the English longitudinal study of ageing. Health Psychol, 2018, 37(2): 160-169.
37.	Valls-Pedret C, Sala-Vila A, Serra-Mir M, et al. Mediterranean diet and age-related cognitive decline: a randomized clinical trial. JAMA Intern Med, 2015, 175(7): 1094-1103.
38.	陈希, 赵丽萍, 张毅, 等. 老年人认知衰弱评估研究进展. 护理学杂志, 2021, 36(4): 109-112.
39.	严雪丹, 陈善萍, 周莉华, 等. 住院共病老年人发生认知衰弱的影响因素及其对预后的影响. 中国全科医学, 2022, 25(31): 3877-3883.
40.	韩君, 王君俏, 谢博钦, 等. Fried衰弱表型和FRAIL量表及埃德蒙顿衰弱评估量表在社区高龄老年人衰弱筛查中一致性和适用性的比较研究. 中国全科医学, 2021, 24(21): 2669-2675.
41.	Ruan Q, D'Onofrio G, Sancarlo D, et al. Emerging biomarkers and screening for cognitive frailty. Aging Clin Exp Res, 2017, 29(6): 1075-1086.

1. Cano A. Cognitive frailty, a new target for healthy ageing. Maturitas, 2015, 82(2): 139-140.
2. Panza F, Lozupone M, Solfrizzi V, et al. Cognitive frailty: a potential target for secondary prevention of dementia. Expert Opin Drug Metab Toxicol, 2017, 13(10): 1023-1027.
3. Shimada H,Doi T, Lee S, et al. Cognitive frailty predicts incident dementia among community-dwelling older people. J Clin Med, 2018, 7(9): 250.
4. Tang KF, Teh PL, Lee SWH. Cognitive frailty and functional disability among community-dwelling older adults: a systematic review. Innov Aging, 2023, 7(1): igad005.
5. Guo X, Pei J, Ma Y, et al. Cognitive frailty as a predictor of future falls in older adults: a systematic review and meta-analysis. J Am Med Dir Assoc, 2023, 24(1): 38-47.
6. Zou C, Yu Q, Wang C, et al. Association of depression with cognitive frailty: a systematic review and meta-analysis. J Affect Disord, 2023, 320: 133-139.
7. Lv X, Li W, Ma Y, et al. Cognitive decline and mortality among community-dwelling Chinese older people. BMC Med, 2019, 17(1): 63.
8. Yu R, Morley JE, Kwok T, et al. The effects of combinations of cognitive impairment and pre-frailty on adverse outcomes from a prospective community-based cohort study of older Chinese people. Front Med (Lausanne), 2018, 5: 50.
9. 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. J Am Geriatr Soc, 2009, 57(3): 453-461.
10. Feng L, Zin Nyunt MS, Gao Q, et al. Cognitive Frailty and Adverse Health Outcomes: Findings From the Singapore Longitudinal Ageing Studies (SLAS). J Am Med Dir Assoc, 2017, 18(3): 252-258.
11. 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 (Albany NY), 2020, 12(22): 23129-23145.
12. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
13. 王丹, 翟俊霞, 牟振云, 等. Meta分析中的异质性及其处理方法. 中国循证医学杂志, 2009, 9(10): 1115-1118.
14. Brigola AG, Ottaviani AC, Alexandre TDS, et al. Cumulative effects of cognitive impairment and frailty on functional decline, falls and hospitalization: a four-year follow-up study with older adults. Arch Gerontol Geriatr, 2020, 87: 104005.
15. Buta B, Friedman AB, Chung SE, et al. The combined effects of physical frailty and cognitive impairment on emergency department- versus direct-admission hospitalizations. BMC Geriatr, 2022, 22(1): 718.
16. Ong JYQ, Mat S, Kioh SH, et al. Cognitive frailty and 5-year adverse health-related outcomes for the Malaysian elders longitudinal research (MELoR) study. Eur Geriatr Med, 2022, 13(6): 1309-1316.
17. Wang J, Kong D, Yu F, et al. Cognitive deficit, physical frailty, hospitalization and emergency department visits in later life. Aging Ment Health, 2021, 25(3): 521-527.
18. Aliberti MJR, Cenzer IS, Smith AK, et al. Assessing risk for adverse outcomes in older adults: the need to include both physical frailty and cognition. J Am Geriatr Soc, 2019, 67(3): 477-483.
19. Aprahamian I, Suemoto CK, Aliberti MJR, et al. Frailty and cognitive status evaluation can better predict mortality in older adults. Arch Gerontol Geriatr, 2018, 77: 51-56.
20. Downer B, Al Snih S, Howrey BT, et al. Combined effects of cognitive impairment and pre-frailty on future frailty and death in older Mexican Americans. Aging Ment Health, 2019, 23(10): 1405-1412.
21. Esteban-Cornejo I, Cabanas-Sánchez V, Higueras-Fresnillo S, et al. Cognitive frailty and mortality in a national cohort of older adults: the role of physical activity. Mayo Clin Proc, 2019, 94(7): 1180-1189.
22. Lee Y, Kim J, Chon D, et al. The effects of frailty and cognitive impairment on 3-year mortality in older adults. Maturitas, 2018, 107: 50-55.
23. Ma Y, Li X, Pan Y, et al. Cognitive frailty predicting death and disability in Chinese elderly. Neurol Res, 2021, 43(10): 815-822.
24. Solfrizzi V, Scafato E, Seripa D, et al. Reversible cognitive frailty, dementia, and all-cause mortality. the Italian longitudinal study on aging. J Am Med Dir Assoc, 2017, 18(1): 81-89.
25. St John PD, Tyas SL, Griffith LE, et al. The cumulative effect of frailty and cognition on mortality - results of a prospective cohort study. Int Psychogeriatr, 2017, 29(4): 535-543.
26. Thein FS, Li Y, Nyunt MSZ, et al. Physical frailty and cognitive impairment is associated with diabetes and adversely impact functional status and mortality. Postgrad Med, 2018, 130(6): 561-567.
27. Wang MC, Li TC, Li CI, et al. Cognitive function and its transitions in predicting all-cause mortality among urban community-dwelling older adults. BMC Psychiatry, 2020, 20(1): 203.
28. Zhang XM, Jiao J, Zhu C, et al. Cognitive frailty and 30-day mortality in a national cohort of older Chinese inpatients. Clin Interv Aging, 2021, 16: 389-401.
29. 康德英, 洪旗, 刘关键, 等. Meta分析中发表性偏倚的识别与处理. 中国循证医学杂志, 2003, 3(1): 45-49.
30. 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. J Nutr Health Aging, 2013, 17(9): 726-734.
31. 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 Ment Health, 2022, 26(3): 464-476.
32. Fabrício DM, Chagas MHN, Diniz BS. Frailty and cognitive decline. Transl Res, 2020, 221: 58-64.
33. Vermeiren S, Vella-Azzopardi R, Beckwée D, et al. Frailty and the prediction of negative health outcomes: a meta-analysis. J Am Med Dir Assoc, 2016, 17(12): 1161-1163.
34. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 2001, 56(3): M146-M156.
35. Fedarko NS. The biology of aging and frailty. Clin Geriatr Med, 2011, 27(1): 27-37.
36. Smith SG, Jackson SE, Kobayashi LC, et al. Social isolation, health literacy, and mortality risk: findings from the English longitudinal study of ageing. Health Psychol, 2018, 37(2): 160-169.
37. Valls-Pedret C, Sala-Vila A, Serra-Mir M, et al. Mediterranean diet and age-related cognitive decline: a randomized clinical trial. JAMA Intern Med, 2015, 175(7): 1094-1103.
38. 陈希, 赵丽萍, 张毅, 等. 老年人认知衰弱评估研究进展. 护理学杂志, 2021, 36(4): 109-112.
39. 严雪丹, 陈善萍, 周莉华, 等. 住院共病老年人发生认知衰弱的影响因素及其对预后的影响. 中国全科医学, 2022, 25(31): 3877-3883.
40. 韩君, 王君俏, 谢博钦, 等. Fried衰弱表型和FRAIL量表及埃德蒙顿衰弱评估量表在社区高龄老年人衰弱筛查中一致性和适用性的比较研究. 中国全科医学, 2021, 24(21): 2669-2675.
41. Ruan Q, D'Onofrio G, Sancarlo D, et al. Emerging biomarkers and screening for cognitive frailty. Aging Clin Exp Res, 2017, 29(6): 1075-1086.

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