# Increased Risk of Transition to Institutional Care Among Community‐Dwelling Older Adults With Cognitive Frailty: A Competing Risks Survival Analysis

## TL;DR

Older adults with cognitive frailty are more likely to move into institutional care, highlighting the need for early interventions to manage this condition.

## Contribution

This study provides new evidence on the increased risk of institutional care transition among individuals with cognitive frailty in a Chinese population.

## Key findings

- The baseline prevalence of cognitive frailty was 2.3% among community-dwelling older adults.
- Cognitive frailty was associated with a 3.51 times higher risk of transitioning to institutional care.
- Individuals with cognitive frailty also faced higher risks of mortality and being lost to follow-up.

## Abstract

Cognitive frailty (CF) is the coexistence of physical frailty and cognitive impairment. Transition to institutional care (TIC) refers to the move from home to a long‐term care institution and represents a major change in living arrangement and care needs among older adults. Both CF and TIC are pressing challenges in ageing populations; however, evidence on their association remains limited.

This study aimed to explore the longitudinal relationship between CF and TIC among community‐dwelling older adults, using the Chinese population as an example.

This retrospective cohort study utilised data from four waves (2008–2018) of the Chinese Longitudinal Healthy Longevity Survey. Community‐dwelling participants aged between 65 and 100 years at baseline were included. CF was defined based on the modified Fried criteria and the Chinese version Mini‐Mental State Examination. The Fine‐Grey subdistribution regression models were used, treating mortality and lost to follow‐up as competing risks and controlling for gender, age, living area, marital status, living arrangement, multimorbidity, household income, and preference for institutional care.

The baseline prevalence of CF was 2.3% (95% CI: 2.0%–2.6%). During follow‐up, 1.2% (95% CI: 1.0%–1.4%) transitioned to institutional care, 47.1% (95% CI: 46.1%–48.2%) died before TIC and 32.1% (95% CI: 31.1%–33.0%) were lost to follow‐up. Incidence rate of TIC was 2.3 (95% CI: 1.9–2.8) per 1000 person‐years. Individuals with CF had a higher risk of TIC (SHR 3.51, 95% CI: 1.49 to 8.28; p = 0.004) compared to those without physical frailty and cognitive impairment.

Our findings demonstrated the positive association between CF and TIC, highlighting the need for appropriate and timely management of CF and personalised interventions for this vulnerable group to delay premature institutionalisation.

The prevalence of cognitive frailty was 2.3% among community‐dwelling older adults without dementia.The incidence of transition to institutional care was 2.3 per 1000 person‐years.Cognitive frailty was associated with an increased risk of transition to institutional care, as well as higher risks of mortality and lost to follow‐up compared to individuals without physical frailty and cognitive impairment.Preventive interventions are required to reduce the risk of developing cognitive frailty and the occurrence of cognitive frailty related adverse outcomes.

The prevalence of cognitive frailty was 2.3% among community‐dwelling older adults without dementia.

The incidence of transition to institutional care was 2.3 per 1000 person‐years.

Cognitive frailty was associated with an increased risk of transition to institutional care, as well as higher risks of mortality and lost to follow‐up compared to individuals without physical frailty and cognitive impairment.

Preventive interventions are required to reduce the risk of developing cognitive frailty and the occurrence of cognitive frailty related adverse outcomes.