Volume 28, Issue 2 pp. 381-388

Original Article

Cognitive frailty and falls in Chinese elderly people: a population-based longitudinal study

Y. Ma,

Y. Ma

Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

Search for more papers by this author

X. Li,

X. Li

Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

Search for more papers by this author

Y. Pan,

Y. Pan

Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

Search for more papers by this author

R. Zhao,

R. Zhao

Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

Search for more papers by this author

X. Wang,

X. Wang

orcid.org/0000-0001-7333-8676

Ministry of Education Key Laboratory of Contemporary Anthropology, Human Phenome Institute, Fudan University, Shanghai, China

Search for more papers by this author

X. Jiang,

Corresponding Author

X. Jiang

[email protected]

Department of Pathology and Pathophysiology, Tongji University School of Medicine, Shanghai, China

Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine, Shanghai, China

Correspondence: X. Jiang, Department of Pathology and Pathophysiology, Key Laboratory of Arrhythmia of the Ministry of Education of China, Tongji University School of Medicine, Shanghai 200092, China (tel.: 86-21-65983213 ; fax: 86-21-65989086; e-mail: [email protected]) and S, Li, Department of Neurology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, PR China (tel.: +86 13661207745; fax: 86-010-85231201; e-mail: [email protected]).

Search for more papers by this author

S. Li,

Corresponding Author

S. Li

[email protected]

orcid.org/0000-0003-4740-9615

Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

Search for more papers by this author

Y. Ma,

Y. Ma

Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

Search for more papers by this author

X. Li,

X. Li

Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

Search for more papers by this author

Y. Pan,

Y. Pan

Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

Search for more papers by this author

R. Zhao,

R. Zhao

Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

Search for more papers by this author

X. Wang,

X. Wang

orcid.org/0000-0001-7333-8676

Ministry of Education Key Laboratory of Contemporary Anthropology, Human Phenome Institute, Fudan University, Shanghai, China

Search for more papers by this author

X. Jiang,

Corresponding Author

X. Jiang

[email protected]

Department of Pathology and Pathophysiology, Tongji University School of Medicine, Shanghai, China

Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine, Shanghai, China

Search for more papers by this author

S. Li,

Corresponding Author

S. Li

[email protected]

orcid.org/0000-0003-4740-9615

Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

Search for more papers by this author

First published: 08 October 2020

https://doi.org/10.1111/ene.14572

Citations: 38

Share a link

Email
Wechat
Bluesky

Abstract

Background and purpose

Falling is considered an important public health problem among older people. A recent cross-sectional study suggested that cognitive frailty (CF) is associated with falls. We aimed to explore whether CF is a risk factor for falls in a population-based longitudinal study.

Methods

Using data from the Rugao Longevity and Aging Study, physical frailty was assessed according to the modified Fried's phenotype, and the 20% of participants with the lowest scores on the Revised Hasegawa Dementia Scale were defined as having cognitive impairment (CoI). Cognitive frailty (CF) was defined as the coexistence of physical frailty and CoI, but excluded severe CoI (revised Hasegawa Dementia Scale score ≤ 10). The outcome of number of falls in the previous 12 months was measured using a questionnaire.

Results

At baseline, the prevalence of CF was 2.6% and the prevalence of two or more falls was 6.7%. Cross-sectional analysis found that two or more falls was associated with physical frailty without CoI (odds ratio [OR] 6.79, 95% confidence interval [CI] 3.17–14.56), pre-frailty with CoI (OR 4.54, 95% CI 2.44–8.44) and CF (OR 3.51, 95% CI 1.18–10.44). Slow gait with CoI was associated with two or more falls (OR 2.21, 95% CI 1.08–4.53). At 3-year follow-up, the prevalence of two or more falls was 10.6%. Logistic regression analysis showed that, compared with the robust and non-CoI elderly groups, the CF elderly group had a higher risk of two or more falls (OR 3.41, 95% CI 1.11–10.50).

Conclusions

Cognitive frailty was associated with two or more falls at baseline and might be a risk factor for two or more falls after 3 years. Early screening of CF might be beneficial in the prevention of falls.

Disclosure of conflicts of interest

The authors declare that there are no financial or other conflicts of interest.

Open Research

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

1Taylor ME, Ketels MM, Delbaere K, Lord SR, Mikolaizak AS, Close JC. Gait impairment and falls in cognitively impaired older adults: an explanatory model of sensorimotor and neuropsychological mediators. Age Ageing 2012; 41: 665–669.
10.1093/ageing/afs057
PubMed Web of Science® Google Scholar
2Crow RS, Lohman MC, Pidgeon D, Bruce ML, Bartels SJ, Batsis JA. Frailty versus stopping elderly accidents, deaths and injuries initiative fall risk score: ability to predict future falls. J Am Geriatr Soc 2018; 66: 577–583.
10.1111/jgs.15275
PubMed Web of Science® Google Scholar
3Peel NM. Epidemiology of falls in older age. Can J Aging 2011; 30: 7–19.
10.1017/S071498081000070X
PubMed Web of Science® Google Scholar
4Guirguis-Blake JM, Michael YL, Perdue LA, Coppola EL, Beil TL. Interventions to prevent falls in older adults: updated evidence report and systematic review for the US preventive services task force. JAMA 2018; 319: 1705–1716.
10.1001/jama.2017.21962
PubMed Web of Science® Google Scholar
5Delbaere K, Close JC, Heim J, et al. A multifactorial approach to understanding fall risk in older people. J Am Geriatr Soc 2010; 58: 1679–1685.
10.1111/j.1532-5415.2010.03017.x
CAS PubMed Web of Science® Google Scholar
6Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas 2013; 75: 51–61.
10.1016/j.maturitas.2013.02.009
PubMed Web of Science® Google Scholar
7Hoffman GJ, Hays RD, Wallace SP, Shapiro MF, Ettner SL. Depressive symptomatology and fall risk among community-dwelling older adults. Soc Sci Med 2017; 178: 206–213.
10.1016/j.socscimed.2017.02.020
PubMed Web of Science® Google Scholar
8Yoo JS, Kim CG, Yim J, Jeon MY. Factors influencing falls in the frail elderly individuals in urban and rural areas. Aging Clin Exp Res 2016; 28: 687–697.
10.1007/s40520-015-0469-2
PubMed Web of Science® Google Scholar
9Jiam NT, Li C, Agrawal Y. Hearing loss and falls: a systematic review and meta-analysis. Laryngoscope 2016; 126: 2587–2596.
10.1002/lary.25927
PubMed Web of Science® Google Scholar
10Fischer BL, Gleason CE, Gangnon RE, Janczewski J, Shea T, Mahoney JE. Declining cognition and falls: role of risky performance of everyday mobility activities. Phys Ther 2014; 94: 355–362.
10.2522/ptj.20130195
PubMed Web of Science® Google Scholar
11Lach HW, Harrison BE, Phongphanngam S. Falls and fall prevention in older adults with early-stage dementia an integrative review. Res Gerontol Nurs 2017; 10: 139–156.
10.3928/19404921-20160908-01
PubMed Web of Science® Google Scholar
12Woo MT, Davids K, Liukkonen J, Chow JY, Jaakkola T. Falls, cognitive function, and balance profiles of Singapore community-dwelling elderly individuals: key risk factors. Geriatr Orthop Surg Rehabil 2017; 8: 256–262.
10.1177/2151458517745989
PubMed Web of Science® Google Scholar
13Kojima G. Frailty as a predictor of future falls among community-dwelling older people: a systematic review and meta-analysis. J Am Med Dir Assoc 2015; 16: 1027–1033.
10.1016/j.jamda.2015.06.018
PubMed Web of Science® Google Scholar
14Cheng MH, Chang SF. Frailty as a risk factor for falls among community dwelling people: evidence from a meta-analysis. J Nurs Scholarsh 2017; 49: 529–536.
10.1111/jnu.12322
PubMed Web of Science® Google Scholar
15Kelaiditi E, Cesari M, Canevelli M, et al. Cognitive frailty: rational and definition from an (IANA/IAGG) international consensus group. J Nutr Health Aging 2013; 17: 726–734.
10.1007/s12603-013-0367-2
CAS PubMed Web of Science® Google Scholar
16Canevelli M, Cesari M. Cognitive frailty: far from clinical and research adoption. J Am Med Dir Assoc 2017; 18: 816–818.
10.1016/j.jamda.2017.07.004
PubMed Web of Science® Google Scholar
17Panza F, Lozupone M, Solfrizzi V, et al. Different cognitive frailty models and health- and cognitive-related outcomes in older age: from epidemiology to prevention. J Alzheimers Dis 2018; 62: 993–1012.
10.3233/JAD-170963
PubMed Web of Science® Google Scholar
18Avila-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: 453–461.
10.1111/j.1532-5415.2008.02136.x
PubMed Web of Science® Google Scholar
19Solfrizzi 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. 89.e1–89.e8.
10.1016/j.jamda.2016.10.012
PubMed Web of Science® Google Scholar
20Feng L, Nyunt MSZ, Gao Q, Feng L, Yap KB, Ng T-P. Cognitive frailty and adverse health outcomes: findings from the singapore longitudinal ageing studies (SLAS). J Am Med Dir Assoc 2017; 18: 252–258.
10.1016/j.jamda.2016.09.015
PubMed Web of Science® Google Scholar
21Tsutsumimoto K, Doi T, Makizako H, et al. Cognitive frailty is associated with fall-related fracture among older people. J Nutr Health Aging 2018; 22: 1216–1220.
10.1007/s12603-018-1131-4
CAS PubMed Web of Science® Google Scholar
22Liu ZY, Wang Y, Zhang YC, et al. Cohort profile: the Rugao Longevity and Ageing Study (RuLAS). Int J Epidemiol 2016; 45: 1064–1073.
PubMed Web of Science® Google Scholar
23Hasegawa K. The clinical issues of age-related dementia. Tohoku J Exp Med 1990; 161: 29–38.
10.1620/tjem.161.Supplement_29
PubMed Google Scholar
24Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: Evidence for a phenotype. J Gerontol Ser A-Biol Sci Med Sci 2001; 56: M146–M156.
10.1093/gerona/56.3.M146
CAS PubMed Web of Science® Google Scholar
25Dennis M, Kadri A, Coffey J. Depression in older people in the general hospital: a systematic review of screening instruments. Age Ageing 2012; 41: 148–154.
10.1093/ageing/afr169
PubMed Web of Science® Google Scholar
26Ma L, Zhang L, Zhang Y, Li Y, Tang Z, Chan P. Cognitive frailty in china: results from china comprehensive geriatric assessment study. Front Med 2017; 4: 174.
10.3389/fmed.2017.00174
Web of Science® Google Scholar
27Kamil RJ, Betz J, Powers BB, et al. Association of hearing impairment with incident frailty and falls in older adults. J Aging Health 2016; 28: 644–660.
10.1177/0898264315608730
PubMed Web of Science® Google Scholar
28Valderrama-Hinds LM, Al Snih S, Chen N-W, Rodriguez MA, Wong R. Falls in Mexican older adults aged 60 years and older. Aging Clin Exp Res 2018; 30: 1345–1351.
10.1007/s40520-018-0950-9
PubMed Web of Science® Google Scholar
29Schlick C, Schniepp R, Loidl V, Wuehr M, Hesselbarth K, Jahn K. Falls and fear of falling in vertigo and balance disorders: a controlled cross-sectional study. J Vestib Res 2016; 25: 241–251.
10.3233/VES-150564
PubMed Web of Science® Google Scholar
30Doi T, Shimada H, Park H, et al. Cognitive function and falling among older adults with mild cognitive impairment and slow gait. Geriatr Gerontol Int 2015; 15: 1073–1078.
10.1111/ggi.12407
PubMed Web of Science® Google Scholar
31Mielke MM, Roberts RO, Savica R, et al. Assessing the temporal relationship between cognition and gait: slow gait predicts cognitive decline in the mayo clinic study of aging. J Gerontol Series A Biol Sci Med Sci 2013; 68: 929–937.
10.1093/gerona/gls256
PubMed Web of Science® Google Scholar

Citing Literature

Volume28, Issue2

February 2021

Pages 381-388

Cognitive frailty and falls in Chinese elderly people: a population-based longitudinal study

Abstract

Background and purpose

Methods

Results

Conclusions

Disclosure of conflicts of interest

Open Research

Data availability statement

References

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Cognitive frailty and falls in Chinese elderly people: a population-based longitudinal study

Abstract

Background and purpose

Methods

Results

Conclusions

Disclosure of conflicts of interest

Open Research

Data availability statement

References

Citing Literature

References

Related

Information