Cognitive frailty increases the risk of long‐term care dependency in community‐dwelling older adults: A nationwide cohort study in South Korea

Aim To investigate whether cognitive frailty, compared with physical frailty or cognitive impairment alone, substantially increased the risk of long‐term care (LTC) initiation in community‐dwelling older adults. Methods Subjects comprised a total of 39 148 participants aged 66 years from the Korean National Health Insurance–Senior cohort database. Cognitive frailty was defined as the coexistence of physical frailty and cognitive impairment, which was measured by the Timed Up and Go test and the Korean Dementia Screening Questionnaire–Prescreening, respectively. A stratified Cox model was estimated to explore the association of frailty status with LTC initiation. Results The baseline prevalence of cognitive frailty was 8.7%. During a mean follow‐up of 5.3 years, 646 older adults started receiving LTC services. Compared with the robust group, older adults with cognitive frailty showed the highest risk of LTC initiation (hazard ratio [HR], 2.65; 95% confidence interval [CI], 2.08–3.35), followed by those with cognitive impairment (HR, 1.62; 95% CI, 1.26–2.07) and physical frailty (HR, 1.50; 95% CI, 1.25–1.81). Furthermore, cognitive frailty in depressed older adults (HR, 3.16; 95% CI, 2.31–4.33) showed a higher risk of LTC initiation than in nondepressed older adults (HR, 2.10; 95% CI, 1.46–3.04). Conclusions Cognitive frailty was a significant predictor of LTC initiation among community‐dwelling older adults, particularly if they are depressed. Early detection and timely intervention may help to delay LTC initiation in older adults with concurrent cognitive frailty and depression. Geriatr Gerontol Int 2023; 23: 117–123 .