A Holistic Approach to Cognitive Frailty in Community-dwelling Older Adults in India: Evidence from a Nationally Representative Survey

Background: Cognitive frailty (CF), a complex intersection of physical frailty (PF) and cognitive impairment (CI), remains inadequately explored in the Indian context. Given its potential link to dementia and reversible characteristics, this study aims to understand the national-level prevalence of CF, its regional variations, and its holistic association with socio-demographic, physical, psychosocial, and lifestyle factors. Methods: The present study employed data from the Longitudinal Ageing Study in India (LASI-Wave-I), a nationally representative survey that included 27,379 individuals (13,293 men and 14,086 women) aged 60+. CF was defined as the presence of both PF and CI without dementia. PF was assessed using the modified Community-Oriented Frailty Index, comprising a 20-item deficits frailty index. CI was evaluated using the composite score, which considered five cognitive domains and seven difficulties with IADL. To investigate the association between the outcome variable (CF) and predictor variables (socio-demographic, physical, psychosocial, and lifestyle factors), the study utilised stepwise binary logistic regression (backward elimination) and presented the results as adjusted odds ratios (AOR) with corresponding 95% confidence intervals. Results: The overall prevalence of CF amongst those aged 60+ was found to be 4.5%, with higher rates evident in the Western (6.2%) and Southern (5.3%) regions. Several factors exhibited significant associations with CF (p < 0.01), including being aged 80 and above (AOR 4.7, 95% CI: 3.9-5.6), being female (AOR 1.6, 95% CI: 1.4-1.9), and having less than primary education (AOR 15.3, 95% CI: 7.2-32.5, p < 0.01). Mobility impairment (AOR 6.7, 95% CI: 4.7-9.8) also exhibited a strong effect on CF. Psychosocial factors, such as low social participation (AOR 2.1, 95% CI: 1.8-2.4), major depression (AOR 1.7, 95% CI: 1.4-2.0), sleep problems (AOR 1.6, 95% CI: 1.4-1.9), and low life satisfaction (AOR 1.4, 95% CI: 1.2-1.6), were also found to have significant associations with CF. Conclusions: This pioneering study outlines the prevalence of CF in India, revealing elevated rates among the community-dwelling population aged over 60 compared to global figures, accompanied by notable regional variations, and underscores the importance of future longitudinal data and targeted investigations for informing policy implications.