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. 2025 Feb 22;25(1):124.
doi: 10.1186/s12877-025-05752-9.

Associations of frailty and cognitive impairment with all-cause and cardiovascular mortality in older adults: a prospective cohort study from NHANES 2011-2014

An-Bang Liu  1   2   3 , Yan-Xia Lin  1 , Guan-Ying Li  4 , Ting-Ting Meng  1   2   3 , Peng Tian  3   5 , Jian-Lin Chen  3   6 , Xin-He Zhang  1   2   3 , Wei-Hong Xu  1   2   3 , Yu Zhang  1   3   5 , Dan Zhang  3   5 , Yan Zheng  7   8
Affiliations

Associations of frailty and cognitive impairment with all-cause and cardiovascular mortality in older adults: a prospective cohort study from NHANES 2011-2014

An-Bang Liu et al. BMC Geriatr. .

Abstract

Background: The global aging trend exacerbates the challenge of frailty and cognitive impairment in older adults, yet their combined impact on health outcomes remains under-investigated. This study aims to explore how frailty and psychometric mild cognitive impairment (pMCI) jointly affect all-cause and cardiovascular disease (CVD) mortality.

Methods: The cohort study we examined 2,442 participants aged ≥ 60, is the secondary analysis from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Frailty was quantified using a 49-item frailty index, while pMCI was determined by three composite cognition scores one standard deviation (SD) below the mean. The associations between frailty, pMCI, comorbidity, and mortality were assessed using weighted Cox proportional hazards models.

Results: Of the participants, 31.37% were frail, 17.2% had pMCI, and 8.64% exhibited both conditions. The cohort was stratified into four groups based on frailty and pMCI status. After a median follow-up period of 6.5 years, frail individuals with pMCI had the highest all-cause (75.23 per 1,000 person-years) and CVD (32.97 per 1,000 person-years) mortality rates. Adjusted hazard ratios (HRs) for all-cause (3.06; 95% CI, 2.05-4.56) and CVD (3.8; 95% CI, 2.07-6.96) mortality were highest in frail older adults with pMCI compared to those who were non-frail without pMCI.

Conclusion: Our study highlights the ubiquity of frailty and cognitive impairment in older adults and underscores the heightened risk of mortality associated with their coexistence. These findings suggest the critical need for proactive screening and management of frailty and cognitive function in clinical practice to improve outcomes for the older adults.

Keywords: Cognition; Frailty; Mortality; Older adults; Psychometric mild cognitive impairment.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The investigation was approved by the NCHS research ethics review board. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The weighted (%) of all-cause and CVD mortality by different frailty and cognitive performance status. Weighted (%) is the mortality of each group of the national population reflected by the follow-up outcome of the included participants after sampling weights calculation
Fig. 2
Fig. 2
Association of frailty / cognition group with all-cause (A) and CVD (B) mortality
Fig. 3
Fig. 3
Kaplan-Meier survival curves for all-cause (A) and CVD (B) mortality stratified by different frailty and cognitive performance status
See this image and copyright information in PMC

References

    1. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62. - PMC - PubMed
    1. Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019;394(10206):1365–75. - PubMed
    1. Dent E, Martin FC, Bergman H, Woo J, Romero-Ortuno R, Walston JD. Management of frailty: opportunities, challenges, and future directions. Lancet. 2019;394(10206):1376–86. - PubMed
    1. Chen X, Mao G, Leng SX. Frailty syndrome: an overview. Clin Interv Aging. 2014;9:433–41. - PMC - PubMed
    1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, et al. Frailty in older adults: evidence for a phenotype. J Gerontol Biol Sci Med Sci. 2001;56(3):M146–156. - PubMed

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