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Cognitive Frailty and 30-Day Mortality in a National Cohort of Older Chinese Inpatients

Authors Zhang XM, Jiao J, Zhu C, Guo N, Liu Y, Lv D, Wang H, Jin J, Wen X, Zhao S, Wu XJ, Xu T

Received 26 November 2020

Accepted for publication 9 February 2021

Published 4 March 2021 Volume 2021:16 Pages 389—401

DOI https://doi.org/10.2147/CIA.S294106

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Prof. Dr. Zhi-Ying Wu


Xiao-Ming Zhang,1,* Jing Jiao,1,* Chen Zhu,1 Na Guo,1 Ying Liu,1 Dongmei Lv,2 Hui Wang,3 Jingfen Jin,4 Xianxiu Wen,5 Shengxiu Zhao,6 Xin-Juan Wu,1 Tao Xu7

1Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan Campus), Beijing, 100730, People’s Republic of China; 2Department of Nursing, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China; 3Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China; 4Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 5Department of Nursing, Sichuan Provincial People’s Hospital, Chengdu, People’s Republic of China; 6Department of Nursing, Qinghai Provincial People’s Hospital, Xining, People’s Republic of China; 7Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, 100005, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xin-Juan Wu; Tao Xu Tel/Fax +010 86 6915 6114
Email [email protected]; [email protected]

Purpose: Studies exploring the association of cognitive frailty and mortality have been mainly based on community settings or nursing home settings. The aim of our study was to explore the association between cognitive frailty and 30-day mortality among older Chinese inpatients.
Patients and Methods: A national cohort study was performed in different hospitals in China. A baseline survey was conducted from October 2018 and February 2019. Trained investigators collected the 30-day mortality. Cognitive impairment and frailty were defined by the Mini-Cog and FRAIL scale, respectively. Multivariate regression was used to explore the association between cognitive impairment and frailty status with 30-day mortality.
Results: Of these participants, there were 3891 (41.91%) women and 5392 (58.09%) men, with an average age of 72.41 (SD=5.72). The prevalence of cognitive frailty was 5.44%. After adjusting for age, gender, education, depression and activities of daily living (ADL), the odds ratios (ORs) for 30-day mortality among inpatients were 3.43 (95% CI: 1.80– 6.55) for cognitive frailty, 1.85 (95% CI: 1.01– 3.41) for frailty only, and 1.43 (95% CI: 0.77– 2.65) for cognitive impairment only compared to the reference group (neither frailty nor cognitive impairment). In addition, the discrimination of 30-day mortality was higher among patients with cognitive frailty (area under the curve =0.676 [95% CI: 0.621– 0.731]) than either frailty (area under the curve =0.644 [95% CI: 0.594– 0.694]) or cognitive impairment (area under the curve = 0.606 [95% CI: 0.556– 0.655]) separately. Stratified analysis showed that these associations still existed when grouped by gender.
Conclusion: Our study found that Chinese inpatients with cognitive frailty had a higher risk of 30-day mortality than those without frailty and cognitive impairment, suggesting that clinicians should be encouraged to perform early screening of patients with frailty and cognitive impairment and carry out effective interventions to reverse cognitive frailty syndrome.

Keywords: frailty, cognitive impairment, mortality, older adults, Chinese; inpatients

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