Disability trajectories and mortality in older adults with different cognitive and physical profiles

Giulia Grande, Davide L Vetrano, Laura Fratiglioni, Anna Marseglia, Nicola Vanacore, Erika Jonsson Laukka, Anna-Karin Welmer, Debora Rizzuto

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Cognitive and physical deficits independently raise the risk for negative events in older adults. Less is known about whether their co-occurrence constitutes a distinct risk profile. This study quantifies the association between cognitive impairment, no dementia (CIND), slow walking speed (WS) and their combination and disability and mortality.

METHODS: We examined 2546 dementia-free people aged ≥ 60 years, part of the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) up to 12 years. The following four profiles were created: (1) healthy profile; (2) isolated CIND (scoring 1.5 SD below age-specific means on at least one cognitive domain); (3) isolated slow WS (< 0.8 m/s); (4) CIND+ slow WS. Disability was defined as the sum of impaired activities of daily living and trajectories of disability were derived from mixed-effect linear regression models. Piecewise proportional hazard models were used to estimate mortality rate [hazard ratios (HRs)]. Population attributable risks of death were calculated.

RESULTS: Participants with both CIND and slow WS had the worst prognosis, especially in the short-term period. They experienced the steepest increase in disability and five times the mortality rate (HR 5.1; 95% CI 3.5-7.4) of participants free from these conditions. Similar but attenuated results were observed for longer follow-ups. Co-occurring CIND and slow WS accounted for 30% of short-term deaths.

CONCLUSIONS: Co-occurring cognitive and physical limitations constitute a distinct risk profile in older people, and account for a large proportion of short-term deaths. Assessing cognitive and physical function could enable early identification of people at high risk for adverse events.

Original languageEnglish
Pages (from-to)1007-1016
Number of pages10
JournalAging Clin. Exp. Res.
Volume32
Issue number6
DOIs
Publication statusPublished - Jun 2020

Keywords

  • cognitive impairment
  • Walking speed
  • survival
  • disability
  • population-based study

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