Cognitive frailty and 5-year adverse health-related outcomes for the Malaysian elders longitudinal research (MELoR) study

Key summary pointsAim To determine the risk of adverse outcomes between prefrail and frail individuals with and without cognitive impairment as well as those with cognitive impairment in isolation compared to robust individuals. Findings Individuals with cognitive frailty were at higher risk of falls and hospitalisation compared robust individuals. Being prefrail was associated with memory worsening while frailty in isolation [7.70 (1.55-38.20)], being prefrail and cognitively impaired [3.35 (1.76-6.39)] and cognitive frailty [6.15 (2.35-16.11)] were associated with sarcopenia at 5-year follow-up. Message The increased risk of falls and hospitalization among those with cognitive frailty appeared to be accounted for by ethnic disparities. In addition, the presence of sarcopenia at 5-year follow-up was associated with frailty at baseline regardless of cognitive status as well as the presence of mild cognitive impairment in those who were prefrail. Purpose To determine the risk of adverse outcomes among prefrail and frail individuals with and without cognitive impairment as well as those with isolated cognitive impairment compared to robust individuals without cognitive impairment. Methods Data from the Malaysian elders longitudinal research (MELoR) study were utilised. Baseline data were obtained from home-based computer-assisted interviews and hospital-based health-checks from 2013 to 2015. Protocol of MELoR study has been described in previous study (Lim in PLoS One 12(3):e0173466, 2017). Follow-up interviews were conducted in 2019 during which data on the adverse outcomes of falls, sarcopenia, hospitalization, and memory worsening were obtained. Sarcopenia at follow-up was determined using the strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire. Results Follow-up data was available for 776 participants, mean (SD) age 68.1 (7.1) years and 57.1% women. At baseline, 37.1% were robust, 12.8% had isolated cognitive impairment, 24.1% were prefrail, 1.0% were frail, 20.2% were prefrail with cognitive impairment, and 4.8% had CF. Differences in age, ethnicity, quality of life, psychological status, function and comorbidities were observed across groups. The association between CF with hospitalisation and falls compared to robust individuals was attenuated by ethnic differences. Pre-frail individuals were at increased risk of memory worsening compared robust individuals [aOR(95%CI) = 1.69 (1.09-2.60)]. Frail [7.70 (1.55-38.20)], prefrail with cognitive impairment [3.35 (1.76-6.39)] and CF [6.15 (2.35-16.11)] were significantly more likely to be sarcopenic at 5-year follow-up compared to the robust group. Conclusions Cognitive frailty was an independently predictor of sarcopenia at 5-year follow-up. The relationship between CF with falls and hospitalization, however, appeared to be accounted for by ethnic disparities. Future studies should seek to unravel the potential genetic and lifestyle variations between ethnic groups to identify potential interventions to reduce the adverse outcomes associated with CF.