Abstract
Objectives
To evaluate joint trajectories of cognition and frailty and their association with
the cumulative burden of patient-reported outcomes, including hospitalization, nursing
home admission, and disability.
Design
Longitudinal study of 754 community-living persons aged 70 or older.
Participants
690 participants who had a baseline and at least one follow-up assessment of cognition
and frailty between 1998 and 2009.
Measurements
Cognition was assessed using the Mini-Mental State Examination (MMSE). Frailty was
defined by the 5 criteria for the Fried phenotype: muscle weakness, exhaustion, low
physical activity, shrinking, and slow walking speed. A group-based, mixture modeling
approach was used to fit the joint trajectories of cognition and frailty. The cumulative
burden of hospitalization, nursing home admission, and disability over 141 months
associated with the joint trajectories was evaluated using a series of generalized
estimating equation Poisson models.
Results
Four joint trajectories were identified, including No cognitive frailty (27.8%), Slow
cognitive decline and progressive frailty (45.5%), Rapid cognitive decline and progressive
frailty (20.2%), and Cognitive frailty (6.5%). For each joint trajectory group, the
interval-specific incidence density rates of all patient-reported outcomes tended
to increase over time, with the exception of hospitalization for which the increasing
trend was apparent only for the Slow cognitive decline and progressive frailty group.
The No cognitive frailty group had the lowest cumulative burden of all patient-reported
outcomes [eg, nursing home admissions, 7.5/1000 person-months, 95% confidence interval
(CI): 4.8-11.7], whereas the Cognitive frailty group had the highest cumulative burden
(eg, nursing home admissions, 381.1/1000 person-months, 95% CI: 294.5-493.1), with
the exception of hospitalization. Compared with the No cognitive frailty group, the
3 other joint trajectory groups all had significantly greater burden of the patient-reported
outcomes.
Conclusion
Community-living older persons exhibit distinct joint trajectories of cognition and
frailty and experience an increasing burden of nursing home admission and disability
as they age, with the greatest burden for those on a cognitive frailty trajectory.
Keywords
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Article info
Publication history
Published online: November 14, 2017
Footnotes
The authors declare no conflicts of interest.
Dr Liu is the recipient of a James Hudson Brown–Alexander B. Coxe Fellowship from Yale School of Medicine, and he also received support from U01AG022376. The study was conducted at the Yale Claude D. Pepper Older Americans Independence Center (P30AG21342) and was supported by a grant from the National Institute on Aging (R01AG17560). Dr. Gill is the recipient of an Academic Leadership Award (K07AG043587) from the National Institute on Aging.
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© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
