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Physical frailty and cognitive impairment is associated with diabetes and adversely impact functional status and mortality |
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| Authors: | Fen Shermaine Thein Ying Li Ma Shwe Zin Nyunt Qi Gao Shiou Liang Wee |
| Affiliation: | 1. Geriatric Education and Research Institute, Singapore;2. Gerontology Research Programme, Department of Psychological Medicine, National University of Singapore, Singapore;3. The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China;4. Faculty of Health and Social Sciences, Singapore Institute of Technology, Singapore |
| Abstract: | Objectives: We investigated whether there was a higher prevalence of cognitive impairment (CI) and/or physical frailty (PF) in persons with diabetes compared to their non-diabetic counterparts, and the individual and combined impact of CI and PF on functional and mortality outcomes among diabetic older persons. Method: Community-living diabetic and non-diabetic participants (N = 2696) aged 55 and above were assessed on CI (MMSE) and PF (CHS criteria) status. Among 486 diabetic persons, we estimated the odds ratio and 95% confidence intervals (OR, 95% CI) of association of CI and/or PF with prevalent IADL and ADL disability and mortality from 11 years of follow up. Results: Diabetes was associated with significantly higher prevalence of CI and/or PF. Adjusted for sex, age, education, smoking, alcohol intake, physical activity, and BMI, diabetes was associated with higher prevalence of PF alone (OR = 2.24, 1.16–4.34) and PF with CI (OR = 2.01, 1.12–3.60), but not with CI alone (OR = 1.02, 0.73–1.44). In multivariable analyses of 486 diabetic older adults, compared to non-frail (NF) and cognitive normal (CN), CI alone was not significantly associated with IADL (OR = 1.06, 0.53–2.10), but PF alone was associated with considerably higher prevalence of IADL (OR = 6.72, 1.84–24.5). PF with CI was associated with the highest prevalence of IADL (OR = 17.8, 3.66–8.68) and ADL disability (OR = 93.8, 23.6–372.4). Whether singly or in combination, PF and/or CI were associated with worse hazard (HR) ratio for mortality outcomes: CI alone (HR = 2.72, 1.48–5.01), PF alone (HR = 4.30, 1.88–9.82) and CI with PF (HR = 8.41, 3.95–17.9). Conclusion: Cognitive impairment and/or physical frailty are powerful prognostic factors identifying people with diabetes at high risk of mortality. |
| Keywords: | Frailty cognitive impairment type 2 disability and mortality |