Cognitive performance and frailty in older adults clients of a
          private health care plan

Faria, Camila de Assis; Lourenço, Roberto Alves; Ribeiro, Pricila Cristina Correa; Lopes, Claudia S

doi:10.1590/S0034-8910.2013047004451

OBJECTIVE

To investigate the association between frailty syndrome and cognitive performance in the older adults and the effect of schooling and age on this association.

METHODS

Data on frailty in older adults from Phase 1 of the FIBRA-RJ Study were analyzed, relating to 737 customers of a private health care provider, aged 65 and over, living in Rio de Janeiro, Southeastern Brazil, between January 2009 and January 2010. Data on socioeconomic and demographic characteristics, medical conditions and functional capacity were collected. Cognitive performance was assessed using the Mini-Mental State Examination (MMSE). Individuals who exhibited three or more of the following features were considered to be frail: unintentional weight loss (≥ 4.5 kg in the last year); feeling self-reported exhaustion, low grip strength, low physical activity level and slowness. The association between frailty and cognitive performance was evaluated using multivariate logistic regression, with adjustment for medical conditions, activities of daily living and socioeconomic variables. We evaluated the age and schooling as possible effect modifiers in this association.

RESULTS

The frail subjects had a higher prevalence of low cognitive performance, compared to not frail or pre-frail, in the three age groups studied (65-74; 75-84; ≥ 85 years), p < 0.001. After adjustment, the association between frailty and cognitive performance was found among older adults individuals aged 75 and older, with an OR_adj= 2.78 (95%CI 1.23;6.27) for those aged 75 to 84 and OR_adj= 15.62 (95%CI 2.20;110.99) for 85 and older. The age variable was an effect modifier in the association between frailty and cognitive performance, χ²(5) = 806.97, p < 0.0001; the same was not the case with schooling.

CONCLUSIONS

Frailty syndrome is associated with cognitive performance in the aging. Age proved to be an effect modifier in this association. The oldest patients showed a more significant association between the two phenomena.

Aged; Frail Elderly; Cognition; Socioeconomic Factors; Health Maintenance Organizations; Cross-Sectional Studies

[1] Correspondence
: Camila de Assis Faria - Rua São Francisco Xavier, 524 7º andar Bloco E - Pavilhão João Lyra Filho - 20550-013 Rio de Janeiro, RJ, Brasil - E-mail: camila_psic@yahoo.com.br

Variable	Cognitive performance

	Total sample		Normal		Decreased

	n	%	n	%	n	%

Gender
Male	220	33.1	165	75.5	55	24.5
Female	517	66.9	350	67.0	167	33.0
Age group (years)
65 to 74	318	40.9	261	82.2	57	17.8
75 to 84	325	46.4	215	66.3	110	33.7
85 to 94	83	12.1	37	44.3	46	55.7
≥ 95	11	0.6	2	13.0	9	87.0
Personal income (minimum wages)
0 to 2	118	16.4	58	49.0	60	51.0
2.1 to 5	244	34.5	163	66.4	81	33.6
5.1 to 8	153	21.7	121	78.9	32	21.1
> 8.1	188	27.5	154	82.0	34	18.0
BADL
Independent	605	82.2	432	71.3	173	28.7
Dependent in 1 activity	123	16.7	80	65.2	43	34.8
Dependent in 2 or more activities	9	1.2	3	32.0	6	67.0
Mean of total years of schooling (SD)	10.11	5.08	11.17	4.78	7.66	4.92
Mean IADL score (SD)	18.80	2.80	19.33	2.27	17.56	3.46
Mean MMSE (SD)	25.55	3.28	27.29	1.63	21.54	2.54

Variable	Poor cognitive performance
Variable	%	P

Have someone to care for them if necessary		0.836
No	31.1
Yes	30.0
Coronary artery disease		0.367
No	29.5
Yes	34.1
Hypertension		0.984
No	30.1
Yes	30.2
CVA Cerebral		0.024
No	29.3
Yes	48.7
Diabetes mellitus		0.264
No	31.2
Yes	26.6
Depression		0.118
No	29.1
Yes	36.9
Arthritis or Osteoarthritis		0.132
No	28.3
Yes	33.7
Cancer		0.750
No	30.0
Yes	32.6
Urinary incontinence		0.026
No	28.2
Yes	37.5
Fecal incontinence		0.835
No	30.1
Yes	31.6
Functional capacity		< 0.001
Independent	23.3
Dependent	35.4

Frailty status	Poor cognitive performance
Frailty status	%	Raw OR	95%CI	Model 1 OR_adj	95%CI	Model 2 OR_adj	95%CI	Model 3 OR_adj	95%CI	Model 4 OR_adj	95%CI

65 to 74 year old age group
Non frail/Pre-frail	17.5	1		1		1		1		1
Frail	24.0	1.48	0.38;5.70	1.43	0.35;5.81	1.36	0.35;5.26	0.72	0.21;2.48	0.65	0.19;2.24
75 to 84 year old age group (n = 325)
Non frail/Pre-frail	31.3	1		1		1		1		1
Frail	55.0	2.68	1.29;5.53	2.47	1.16;5.28	2.60	1.23;5.48	2.59	1.19;5.66	2.78	1.23;6.27
≥ 85 years old age group (n = 94)
Non frail/Pre-frail	48.4	1		1		1		1		1
Frail	85.5	6.39	1.82;22.42	6.31	1.76;22.62	5.49	1.51;19.90	12.07	2.49;58.53	15.62	2.20;110.99

Brasil

Brasil

Cognitive performance and frailty in older adults clients of a private health care plan

OBJECTIVE

METHODS

RESULTS

CONCLUSIONS