Joint Trajectories of Cognition and Frailty and Associated Burden of Patient-Reported Outcomes.
Zuyun Liu, Ling Han, Evelyne A Gahbauer and 2 others
PMID 29146224WHAT IT FOUND
Older adults followed over 11 years fell into four cognition-frailty paths.
The path with both cognitive decline and worsening frailty had the highest nursing home and disability burden, while hospitalization did not track it as clearly.
Key findings
01Older adults fell into four joint trajectories of cognition and frailty: no cognitive frailty, slow cognitive decline and progressive frailty, rapid cognitive decline and progressive frailty, and cognitive frailty.
02Compared with the no cognitive frailty group, the other three groups had significantly greater cumulative burden of hospitalization, nursing home admission, and disability. The cognitive frailty group had the highest burden of nursing home admission and disability, but not hospitalization.
03The adjusted rate ratios for nursing home admission, compared with the no cognitive frailty group, were 7.2 for slow cognitive decline and progressive frailty, 23.5 for rapid cognitive decline and progressive frailty, and 50.7 for cognitive frailty.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study reports associations between trajectories and outcomes, not proof that cognition or frailty caused hospitalization, nursing home admission, or disability. Participants were from a single health plan in New Haven, CT, and were oversampled for slow gait speed, so results may not apply to older adults elsewhere. Ceiling effects occurred for mobility and IADL disability, making later changes in those outcomes difficult to detect. Hospitalization did not track the cognition and frailty trajectories as closely as nursing home admission and disability.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not conclude that identifying or treating cognitive frailty will prevent nursing home admission or disability. This was an observational study, and the associations between trajectories and outcomes were not causal.