Cognitive deficit, physical frailty, hospitalization and emergency department visits in later life

Objectives: To examine the added effect of having both cognitive deficit and physical frailty, compared to having either one only, on hospitalization and emergency department (ED) visits. Methods: Data from a population-based study of 3,157 community-dwelling older (≥60 years) Chinese adults in the U.S. were used. Cognitive deficit was measured by the Mini-Mental State Examination (i.e. education-adjusted score: 16 [illiterate], 19 [primary school], and 23 [≥middle school]). Physical frailty was identified using the Short Performance Physical Battery (0–6 out of 15). The numbers of hospitalizations and ED visits in the previous two years were self-reported. Results: In this sample, 12.63% had cognitive deficit alone, 5.95% had physical frailty alone, and 4.26% had both. Compared with participants having neither cognitive deficit nor physical frailty, those having physical frailty alone were 1.5 times as likely to have hospitalizations (Rate Ratio [RR] = 1.52 [1.07, 2.16], p = 0.02) and ED visits (RR = 1.52 [1.07, 2.15], p = 0.02). Having cognitive deficit alone was not significantly related to either outcome. However, having cognitive deficit with existing physical frailty increased the likelihood of both hospitalization (RR = 2.00 [1.36, 2.96], p < 0.001) and ED visits (RR = 2.04 [1.37, 3.03], p < 0.001) to a greater extent than having physical frailty alone. Conclusion: Having cognitive deficit alone was not significantly related to the likelihood of hospitalizations or ED visits, however having cognitive deficit with existing physical frailty increased the likelihood of both outcomes to a greater degree than having physical frailty alone. This suggests cognitive deficit and physical frailty have synergistic effects on hospitalizations and ED visits.