Associations of Frailty, Sleep Quality, and Functional Dependence with Cognitive Function Among Institutionalized Older Adults in Indonesia: A Cross-Sectional Study

Cognitive impairment is prevalent among older adults in long-term care settings, yet evidence from Indonesian nursing homes remains sparse. To examine cross-sectional associations between frailty, sleep quality, functional dependence, and cognitive function among institutionalized older adults in Indonesia. Methods: A cross-sectional, multi-site study was conducted with 218 residents (aged ≥ 60 years) from three nursing homes in Greater Jakarta (January-March 2026). Cognitive function was measured using the Mini-Mental State Examination, frailty using the FRAIL Scale, sleep quality using the Single-Item Sleep Quality Scale, and functional dependence using the Barthel Index. Hierarchical multiple linear regression was performed adjusting for sociodemographic and clinical covariates. Participants had a mean age of 71.8 years (SD = 7.6); 61.5% were female. Cognitive impairment (MMSE < 24) was identified in 58.7% of participants. In the final model, frailty (β = -.31), sleep quality (β = .24, indicating that better sleep quality was associated with higher cognitive scores), and functional dependence (β = .29) were each independently associated with cognitive performance. The three geriatric syndromes explained 22.6% additional variance, with the overall model accounting for 46.2% of variance (Cohen's f2 = 0.86). Frailty, lower sleep quality, and functional dependence demonstrated independent associations with cognitive impairment in this sample.