Cognitive frailty and pre-cognitive frailty in Chinese middle-aged and older adults: prevalence, risk factors, mortality

The age-specific prevalence, risk factors, and magnitude of the association between cognitive frailty and mortality in middle-aged and older adults remains unclear. We used baseline (2011) and follow-up wave (2013, 2015, and 2018) data from the China Health and Retirement Longitudinal Study (CHARLS). The age group was categorized as middle-aged, old, and very old. Factors associated with cognitive frailty and the associations between cognitive frailty and mortality were examined using multinomial logistic regression and adjusted Cox proportional hazards models, respectively. We included 7,947 individuals aged 58.14 ± 8.99 years in this study. The overall prevalence of cognitive frailty was 12% (45–64 years old, 11%; 65–74 years old, 10%; ≥75 years old, 26%). Cognitive frailty was significantly associated with rural residential status, physical inactivity, long sleep duration, lack of social participation, depressive symptoms, and multimorbidity among all the age groups. Over the 7-year follow-up, participants with cognitive frailty were at higher risk for all-cause mortality than the robust group among all age groups (HR 1.70, 95%CI 1.12–2.57 for the middle-aged group, HR 1.70, 95%CI 1.02–2.84 for the old group, and HR 2.06, 95%CI 1.17–3.65 for the very old group). However, pre-cognitive frailty was associated with a higher mortality risk in the middle-aged group only (HR 1.34, 95%CI 1.01–1.79). Cognitive frailty, a predictive factor for mortality, was associated with multiple physical, psychological, and lifestyle factors, highlighting the need for comprehensive cognitive frailty prevention strategies. Noticeably, pre-cognitive frailty in middle-aged people increases mortality risk and requires special attention and further studies.