Coexisting Frailty and Cognitive Impairment as a Predictor of Adverse Outcomes in Older Inpatients After Discharge: Results from a One-Year Follow-Up Study

Xing-Kun Zeng,&ast; Shan-Shan Shen,&ast; Hui-Lan Guan, Ling-Yan Chen, Xu-Jiao Chen Department of Geriatrics, Zhejiang Hospital, Hangzhou, Zhejiang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xu-Jiao Chen, Department of Geriatrics, Zhejiang Hospital, Lingyin Road &num;12, Hangzhou, 310013, People’s Republic of China, Tel +86 180 6989 7567, Fax +86 571 8798 5100, Email lily197459@163.comPurpose: This study aimed to investigate the combined effects of frailty and cognitive impairment on adverse outcomes, including new falls and new activities of daily living (ADL) dependency over a 1-year follow-up.Patients and Methods: A total of 311 older hospitalized patients participated in this retrospective observational study and completed a 1-year follow-up. Frailty was assessed by the Clinical Frailty Scale (CFS). Cognitive function was evaluated by the Mini-Mental State Examination (MMSE). All participants were classified into four groups: 1) the healthy group (n=180); 2) the cognitive impairment group only (n=38); 3) the frailty group only (n=44); and 4) coexisting frailty and cognitive impairment group (n=49). The follow-up data of adverse outcomes include the incidences of new falls and new ADL dependence. Binary logistic regression analysis was used to explore the associations of frailty and/or cognitive impairment with adverse outcomes.Results: The prevalence rates of frailty, cognitive impairment, and co-occurring frailty with cognitive impairment were 29.9%, 28%, and 15.8%, respectively. Among these four groups, there was a statistical difference in the incidence of new ADL dependence during the follow-up period (9.5% vs 11.4% vs 35.9% vs 61.9%, P < 0.001). After adjusting the confounding variables, older hospitalized patients with frailty and cognitive impairment had a higher risk of new ADL dependence when compared with the healthy group (OR: 4.786, 95% CI: 1.492– 15.355), but frailty only or cognitive impairment only was not associated with new ADL dependency.Conclusion: Elderly inpatients with comorbid frailty and cognitive impairment on admission were significantly associated with an increased risk of new ADL dependency 1 year after discharge. Therefore, it is necessary for the early identification of frailty and cognitive impairment, and effective interventions should be implemented.Keywords: cognitive impairment, frailty, older adults, ADL dependency, fall