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August 17, 2025Open Access

The Impact of Frailty, Activity of Daily Living, and Malnutrition on Mortality in Older Adults with Cognitive Impairment and Dementia

ZWZitong WangHebei Medical University YDYuqi DongSun Yat-sen University SKShikha KumariNational University Hospital

Key Points

Malnutrition risk independently predicts short-term mortality in older adults with dementia or cognitive impairment, emphasizing the need for early intervention.
30-day mortality significantly linked to frailty and malnutrition risk, particularly among patients aged 65 and older.
Study employed a retrospective cohort analysis of 2677 hospitalized patients aged 65 and older, utilizing medical records for data collection.
Findings highlight the importance of addressing frailty and malnutrition to improve health outcomes in the elderly population.

Abstract

Background: Malnutrition contributes to frailty dementia, intensifying adverse health outcomes including mortality risk. Objectives: We aim to investigate the impact of malnutrition risk in those with frailty and functional decline on short-term mortality among older adults with dementia and/or cognitive impairment. Methods: We conducted a retrospective cohort study involving 2677 hospitalized patients aged ≥65 years with a diagnosis of dementia or cognitive impairment discharged between March 2022 and December 2023. Information was obtained from electronic medical records. Frailty was assessed using the Clinical Frailty Scale (CFS) and Hospital Frailty Risk Score (HFRS), functional status using premorbid activity of daily living (ADL) scores, and malnutritional risk using the 3-Minute Nutrition Screening (3-Min NS) tool. Associations with 30- and 90-day mortality were examined using Kaplan–Meier analysis and multivariate logistic regression models. Results: A total of 29.2% were at risk of malnutrition, highest in the old-old (37.1%). Thirty-day mortality was significantly associated with CFS (aOR = 1.498, 95% CI: 1.349–1.664, p < 0.001), HFRS (aOR = 1.020, 95% CI: 1.001–1.040, p = 0.038), and ADL (aOR = 0.819, 95% CI: 0.753–0.890, p < 0.001). Malnutrition risk demonstrated the strongest association across all models (ADL: aOR = 2.573, 95% CI: 1.922–3.443, p < 0.001; CFS: aOR = 2.348, 95% CI: 1.738–3.156, p < 0.001; HFRS: aOR = 2.944, 95% CI: 2.210–3.922, p < 0.001). Associations between 90-day mortality and malnutrition risk remained significant across all models, including those adjusted for CFS and ADL. Notably, interactions between malnutrition and CFS further amplified mortality risk among the old-old (30-day: aOR = 1.435, 95% CI: 1.082–1.902, p = 0.012; 90-day: aOR = 1.263, 95% CI: 1.005–1.588, p = 0.045). Conclusions: Risk of malnutrition independently predicted short-term mortality in older adults with dementia or cognitive impairment, particularly among those with frailty, functional decline, and of advanced age.

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