Research Paper Volume 12, Issue 22 pp 23129—23145

Cognitive frailty in relation to adverse health outcomes independent of multimorbidity: results from the China health and retirement longitudinal study

Chen Chen1,2, , JuYoung Park3, , Chenkai Wu4,5, , QianLi Xue6, , George Agogo7,8, , Ling Han8, , Emiel O. Hoogendijk9, , Zuyun Liu8,10, , Zunyou Wu1, ,

  • 1 National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
  • 2 National Institute of Environmental and Health, Chinese Center for Disease Control and Prevention, Beijing, China
  • 3 Florida Atlantic University, Phyllis and Harvey Sandler School of Social Work, Boca Raton, FL 33431, USA
  • 4 Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
  • 5 Duke Global Health Institute, Duke University, Durham, NC 27710, USA
  • 6 Division of Geriatric Medicine and Gerontology and Center on Aging and Health, Johns Hopkins Medical Institute, Baltimore, MD 21224, USA
  • 7 Centers for Disease Control and Prevention (CDC), Village Market, Nairobi, Kenya
  • 8 Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
  • 9 Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC-location VU University Medical Center, Amsterdam, Netherlands
  • 10 Department of Big Data in Health Science, School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

Received: June 15, 2020       Accepted: September 5, 2020       Published: November 18, 2020
How to Cite

Copyright: © 2020 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Our objectives were to evaluate: 1) the associations of cognitive frailty with various health outcomes including disability, hospitalization, and death; 2) whether the associations differed by multimorbidity. We included data of 5113 Chinese older adults (aged 60+ years) who had baseline cognition and physical frailty assessments (2011 wave) and follow-up for 4 years. About 16.0% (n=820) had cognitive impairment; 6.7% (n=342) had physical frailty; and 1.6% (n=82) met criteria for cognitive frailty. Both cognitive impairment (odds ratios (ORs) range: 1.41 to 2.11) and physical frailty (ORs range: 1.51 to 2.43) were independently associated with basic activities of daily living (BADL), instrumental ADL (IADL), mobility disability, hospitalization, and death among participants without that corresponding outcome at baseline, even after accounting for covariates. Relative to participants who had normal cognition and were nonfrail, those with cognitive frailty had the highest risk for IADL disability (OR=3.40, 95% CI, 1.23–9.40) and death (OR=3.89, 95% CI, 2.25–6.47). We did not find significant interaction effects between cognitive frailty and multimorbidity (Pinteractions>0.05). Overall, cognitive frailty was associated with disability and death, independent of multimorbidity. This highlights the importance of assessing cognitive frailty in the community to promote primary and secondary preventions for healthy aging.


CHARLS: China Health and Retirement Longitudinal Study; BADL: Basic activities of daily living; IADL: Instrumental activities of daily living; TICS: Telephone Interview of Cognitive Status.