Present Status,Risk Factors And Outcomes Of Cognitive Frailty In Hospitalized Patients

Objectives:To investigate the prevalence of cognitive frailty in the elderly inpatients with comorbidities,related risk factors,and to analysis the mortality risk of the elders with cognitive frailty.Methods:This is a retrospective cohort study.The general demographic characteristics,disease status,nutritional status,physical function status,cognitive function status and other information was collected from 554 elderly people aged 60 and above who were hospitalized in ACE Unit of Geriatrics Department of our hospital between August 2015 and February 2018.According to whether they had both frailty/pre-frailty and cognitive impairment,the patients were divided into non-cognitive frailty group(466 cases)and cognitive frailty group(88 cases).The general demographic characteristics and clinical data were compared to understand the distribution of cognitive frailty,and the risk factors of cognitive frailty were analyzed.Subjects were followed up by telephone in January 2020,to calculate the total mortality during the whole follow-up period and to analysis whether the patients with cognitive frailty was at a higher risk of death.Statistical methods:Chi-square test,t test,multivariate logistic regression,Cox proportional risk regression.All data were analyzed by SPSS 23.0 software.P<0.05 was considered statistically significant.Results:(1)15.9%(88/554)of the elderly inpatients with comorbidities had cognitive frailty.(2)Compared with the non-cognitive frailty group,patients in cognitive frailty group were older,had lower educational background and family care scores,had more patients with malnutrition,depression,ADL independence and balance dysfunction(P<0.05);There was no statistical significance in BMI,CCI,whether the spouse was alive,whether there was a caregiver,smoking,alcohol consumption,coronary heart disease,hypertension,chronic obstructive pulmonary disease,osteoporosis,osteoarthritis,congestive heart failure,sleep disorders,diabetes,etc.(3)Using cognitive frailty as the dependent variable,multivariate Logistic regression analysis showed that malnutrition(OR=3.094,95%CI=1.499-6.383;P<0.05),balance dysfunction(OR=3.004,95%CI=1.341-6.729;P<0.05)and family care dysfunction(OR=0.843,95%CI=0.719-0.989;P<0.05)were independent risk factors of cognitive frailty.(4)During the follow-up period,a total of 410 patients survived,112 patients died and 32 patients lost in the follow-up.Compared with the survival group,the death group had older age,had lower scores of BMI and MMSE,higher scores of frailty,CCI,more patients with malnutrition,ADL independence,balance dysfunction,congestive heart failure,and diabetes(P<0.05).There was no statistical significance association with family care dysfunction,the spouse was alive or not,have caregiver or not,smoking abuse,alcohol consumption,educational background,depression,coronary heart disease,hypertension,osteoporosis,osteoarthritis,etc.(5)Cox regression analysis of 554 hospitalized elderly patients with all-cause mortality showed that patients with cognitive frailty were associated with a higher risk of death(HR=1.967,95%CI=1.293-2.994;P<0.05).Conclusion:Malnutrition,balance dysfunction and less of family care are independent risk factors for cognitive frailty.Older patients with cognitive frailty are at higher risk of mortality.