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Abstract
Purpose
Studies exploring the association of cognitive frailty and mortality have been mainly based on community settings or nursing home settings. The aim of our study was to explore the association between cognitive frailty and 30-day mortality among older Chinese inpatients.
Patients and Methods
A national cohort study was performed in different hospitals in China. A baseline survey was conducted from October 2018 and February 2019. Trained investigators collected the 30-day mortality. Cognitive impairment and frailty were defined by the Mini-Cog and FRAIL scale, respectively. Multivariate regression was used to explore the association between cognitive impairment and frailty status with 30-day mortality.
Results
Of these participants, there were 3891 (41.91%) women and 5392 (58.09%) men, with an average age of 72.41 (SD=5.72). The prevalence of cognitive frailty was 5.44%. After adjusting for age, gender, education, depression and activities of daily living (ADL), the odds ratios (ORs) for 30-day mortality among inpatients were 3.43 (95% CI: 1.80–6.55) for cognitive frailty, 1.85 (95% CI: 1.01–3.41) for frailty only, and 1.43 (95% CI: 0.77–2.65) for cognitive impairment only compared to the reference group (neither frailty nor cognitive impairment). In addition, the discrimination of 30-day mortality was higher among patients with cognitive frailty (area under the curve =0.676 [95% CI: 0.621–0.731]) than either frailty (area under the curve =0.644 [95% CI: 0.594–0.694]) or cognitive impairment (area under the curve = 0.606 [95% CI: 0.556–0.655]) separately. Stratified analysis showed that these associations still existed when grouped by gender.
Conclusion
Our study found that Chinese inpatients with cognitive frailty had a higher risk of 30-day mortality than those without frailty and cognitive impairment, suggesting that clinicians should be encouraged to perform early screening of patients with frailty and cognitive impairment and carry out effective interventions to reverse cognitive frailty syndrome.
Abbreviations
ADL, activities of daily living; OR, odds ratio; MNA-SF, Mini-Nutritional Assessment-Short Form; CFS, Clinical Frailty Scale; MMSE, Mini-Mental State Examination; MoCA, Montreal Cognitive Assessment; CHS criteria, Cardiovascular Health Study; AUC, area under the curve; GDS, Geriatric Depression Scale GDS.
Data Sharing Statement
Deidentified data are accessible on reasonable request via e-mail to the corresponding author.
Ethical Statement
The study was approved by Ethics Committee of Peking Union Medical College Hospital (number S-K540). In addition, participants have provided written informed consent for this project. The authors confirm that this study was conducted in accordance with the Declaration of Helsinki.
Author Contributions
All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.
Disclosure
The authors declare no competing interests in this work.