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Physical Frailty and Cognitive Function among Older Chinese Adults: The Mediating Roles of Activities of Daily Living Limitations and Depression

  • Original Research
  • Physical Frailty
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Abstract

Background

Physical frailty and cognitive impairment are prevalent globally, particularly in China, which is experiencing an unprecedented aging of its large population.

Objectives

Examine the association between physical frailty and the level and rate of change of cognitive function, globally and by domain, among community-dwelling Chinese older adults, and quantify the mediation effects from activities of daily living (ADL) limitations and depressive symptoms.

Design

Longitudinal.

Setting

China Health and Retirement Longitudinal Study (2011–2018).

Participants

5,431 eligible adults aged ≥ 60 years with valid information on physical frailty.

Measurements

Physical frailty, cognitive function, ADL limitations, and depressive symptoms were respectively assessed by frailty phenotypes, the Telephone Interview for Cognitive Status (episodic memory, executive function, and orientation), performance in six daily tasks, and the eight-item Center for Epidemiological Studies Depression Scale. Latent growth curve models were used to address the objectives.

Results

Compared to adults who were non-frail, those who were pre-frail (β = −0.06) and frail (β = −0.13) reported significantly worse global cognitive function and episodic memory (pre-frail: β = −0.05; frail: β = −0.14), executive function (pre-frail: β = −0.04, frail: β = −0.10), and orientation (pre-frail: β = −0.06; frail: β = −0.07) at baseline; those who were frail were more likely to experience faster decline in global cognitive function (β = 0.12) and episodic memory (β = 0.08). ADL limitations (β = −0.07) and depressive symptoms (β = −0.14) significantly mediated the association between physical frailty and the level of cognitive function, but not its rate of decline.

Conclusions

Intervention strategies that help maintain cognitive function may benefit from early screening and assessment of physical frailty. For pre-frail and frail older Chinese adults, programs designed to help improve or maintain activities of daily living and reduce number of depressive symptoms may contribute to better cognitive performance.

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Acknowledgments

This analysis uses data from the Harmonized CHARLS dataset and Codebook, Version D as of June 2021, developed by the Gateway to Global Aging Data. The development of the Harmonized CHARLS was funded by the National Institute on Aging (R01 AG030153, RC2 AG036619, R03 AG043052). For more information, please refer to https://g2aging.org/.

Funding

Funding information: Yiyang Yuan was supported by National Institute on Aging (grant number 5F99AG068591).

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Authors and Affiliations

  1. Department of Gerontology, John W. McCormack Graduate School of Public and Global Studies, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125-3393, USA

    Changmin Peng & J. A. Burr

  2. Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA

    Y. Yuan & K. L. Lapane

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  1. Changmin Peng
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Correspondence to Changmin Peng.

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Ethical standards: This was a secondary data analysis of existing datasets that did not involve human subjects.

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Conflict of interest: All authors declare that there is no conflict of interest.

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Peng, C., Burr, J.A., Yuan, Y. et al. Physical Frailty and Cognitive Function among Older Chinese Adults: The Mediating Roles of Activities of Daily Living Limitations and Depression. J Frailty Aging 12, 156–165 (2023). https://doi.org/10.14283/jfa.2023.1

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