A holistic approach to cognitive frailty in community-dwelling older adults in India: evidence from a nationally representative survey

Background and objectives: Cognitive frailty (CF), the complex overlap of physical frailty and cognitive impairment, remains underexplored in India. Given CF’s association with dementia and its potential reversibility, this study aims to (1) estimate the national prevalence of CF, (2) examine regional disparities in its distribution and (3) identify factors associated with CF in community-dwelling older adults in India. Research design and methods: This cross-sectional study used data from the Longitudinal Ageing Study in India (Wave I), a nationally representative survey of 27,379 adults aged ≥ 60 years (13,293 men; 14,086 women). CF was defined as the co-occurrence of physical frailty and cognitive impairment, excluding dementia. Physical frailty was assessed using a modified Community-Oriented Frailty Index (a 20-item deficits-based measure). Cognitive impairment was operationalised as a composite score derived from five cognitive domains and seven instrumental activities of daily living difficulties. Results: The weighted prevalence of CF was 4.8 per cent in the overall sample, with the highest prevalence observed in the West region (5.7 per cent). Significant associations were identified for age ≥ 80 years, female gender and low educational attainment. Self-reported poor health, low social participation, depression and low life satisfaction also showed significant associations. Conclusions: This study highlights the prevalence, regional disparities and multifactorial contributors to CF in India. Findings underscore the urgency of adopting holistic interventions – integrating physical, functional and psychosocial strategies – into public health policies to mitigate CF and promote healthy ageing.