Association between frailty and cognitive performance across healthcare settings

Abstract Objective: To examine the association between frailty and longitudinal cognitive decline in older adults across different healthcare settings. Methods: This is a multicenter longitudinal cohort study. A total of 1,440 individuals aged ≥75 years from five European countries were recruited from four clinical settings: geriatric inpatient wards, geriatric outpatient clinics, primary care, and nursing homes. Cognitive outcomes were assessed using the Mini-Mental State Examination (MMSE) and the Clinical Dementia Rating (CDR) at baseline and after 1-year follow-up. Frailty was evaluated using eight instruments: the Frailty Phenotype, FRAIL scale, SHARE-FI, 3-item Frailty Trait Scale (FTS-3), 5-item Frailty Trait Scale (FTS-5), 35-item Frailty Index (FI-35), Gérontopôle Frailty Screening Tool (GFST), and the Clinical Frailty Scale (CFS). To explore the association between frailty and cognitive decline, we used linear regression (MMSE), and logistic regression models (CDR). All models were adjusted for age, sex, and Charlson Comorbidity Index and stratified by clinical setting. Results: Among the 1,440 participants included from five European countries, most frailty scales were significantly associated with cognitive decline and clinically significant cognitive impairment. Particularly the FI-35 [△MMSE β (95%CI) -2.00 (-2.32, -1.69); CDR OR (95%CI) 4.81 (3.78, 6.13)] and FTS-5 △MMSE β (95%CI) -2.02 (-2.37, -1.66); CDR OR (95%CI) 4.49 (3.40, 5.93) scale, showed the most consistent associations with both cognitive outcomes. Although the magnitude of associations varied across healthcare settings, frailty measures remained significant predictors in several environments, particularly in hospital-based and institutional settings. Conclusions: Frailty is strongly associated with cognitive decline in older adults across different care settings. Incorporating frailty assessment into routine clinical practice may facilitate earlier identification of individuals at risk of cognitive decline and support the development of targeted preventive strategies.