Cognitive frailty and associated factors in older adults with type 2 diabetes in rural Vietnam

Cognitive frailty, defined as the co-occurrence of frailty and cognitive impairment in the absence of dementia, is a strong predictor of adverse health outcomes in older adults. However, evidence on cognitive frailty among older adults with type 2 diabetes mellitus (T2DM) in low- and middle-income countries remains limited. This study aimed to determine the prevalence of cognitive frailty and its associated factors among older adults with T2DM in rural Vietnam. We conducted a cross-sectional study among outpatients aged ≥ 60 years with T2DM at a provincial hospital in Phu Tho, Vietnam, from July to December 2024. Cognitive frailty was defined as the presence of both frailty (Fried phenotype) and cognitive impairment (Mini-Cog test score < 3) without dementia. Sociodemographic, clinical, diabetes-related, and geriatric variables were collected. Multivariable logistic regression was used to identify independent factors associated with cognitive frailty. Among 840 participants (mean age 73.4 ± 6.8 years; 56.8% female), the prevalence of cognitive frailty was 4.5%, while 9.4% had physical frailty alone. Cognitive frailty was independently associated with advanced age (OR = 1.1, 95%CI 1.07–1.2), functional dependence (OR = 9.2, 95%CI 4.3–19.9), depression symptoms (OR = 3.8, 95%CI 1.6–9.2), risk of malnutrition or malnutrition (OR = 4.8, 95%CI 1.4–16.7) and having HbA1c ≥ 9.0% (OR = 2.4, 95%CI 1.08–5.3). Affected individuals exhibited poorer glycaemic control, higher complication rates, greater risk of malnutrition, and more frequent depressive symptoms compared with non-frail participants. Cognitive frailty among older adults with T2DM in rural Vietnam was associated with age, functional dependence, depression symptoms, risk of malnutrition or malnutrition and poor glycaemic control, highlighting the need for routine frailty screening and multidomain interventions. Incorporating simple, low-cost assessment tools into diabetes care at primary and provincial levels could enable early detection and tailored management for this vulnerable population.