Cognitive Frailty as a Predictor of Future Falls in Older Adults: A Systematic Review and Meta-Analysis

The risk prediction models for cognitive frailty in the older people in China: a systematic review and meta-analysis

BACKGROUND

Recently, many risk prediction models for Cognitive Frailty (CF) in older people in China have been developed. However, there is a shortage of large-scale systematic and comprehensive studies of the methods, quality, and predictors involved in model development.

AIMS

To systematically assess the risk prediction model of CF in older people in China and to conduct a meta-analysis of its predictors.

METHODS

PubMed, Cochrane Library, EMbase, Web of Science, CNKI, Wanfang, VIP, and SinoMed were searched from the inception to April 30, 2024. Two researchers independently screened the literature and extracted data. The quality of studies was assessed using the PROBAST tool. Additionally, Stata 18.0 software and MedCalc software were employed to perform a meta-analysis of the modeled predictors and area under the curve (AUC).

RESULTS

17 articles were included, encompassing 22 CF risk prediction models, involving 9,614 participants, of which 2488 (25.9%) were diagnosed with CF. 15 models reported discrimination by AUC (0.710 to 0.991). 8 models conducted internal validation, while 7 models performed external validation. PROBAST evaluation results found that 15 articles (15/17, 88.24%) exhibited a high risk of bias (ROB). The most common predictors were advanced age, irregular exercise, malnutrition, depression, Barthel Index score, female gender, and Instrumental Activities of Daily Living (IADL) score.

CONCLUSION

Due to imprecise modeling methods, incomplete presentation, and lack of external validation, the models' usefulness still needs to be determined. Seven predictive factors are established predictors for CF among older people, including advanced age and so on, but the roles of educational level and fall incidents warrant further investigation.

Effects of comprehensive intervention models on cognitive frailty in community-dwelling older adults: A 12-month follow-up study

BACKGROUND

Cognitive frailty (CF) is of concern because of its high prevalence in older population and its close association with adverse health outcomes. However, interventions against CF in China are relatively simple. Therefore, the purpose of this study was to analyse the effects of comprehensive interventions on CF in community-dwelling older adults.

METHODS

225 participants, including 108 individuals with reversible CF (RCF) and 117 individuals with potentially RCF (PRCF) were recruited and divided into intervention and control groups. Participants in RCF Intervention Group underwent primary intervention, and participants in PRCF Intervention Group underwent secondary intervention. CF reversal rate and MoCA score were recorded.

RESULTS

Primary intervention and secondary intervention could well reversed CF. Additionally, MoCA scores changed significantly.

CONCLUSIONS

Adhering to regular comprehensive interventions can effectively reverse CF for community-dwelling older adults. Additionally, RCF maybe is an effective target for reversing CF via early intervention.

Relationship Between Executive Function Subdomains and Postural Balance in Community-Dwelling Older Adults

BACKGROUND

Executive function (EF) deficits are a significant risk factor for falls among older adults (OAs). However, relationship between EF subdomains (shifting, updating, and inhibition), postural balance (PB), and fall risk in healthy OAs, remains poorly understood.

OBJECTIVE

This study aimed to investigate the relationship between EF subdomains (shifting, updating, and inhibition) and PB, and to assess their impact on risk of falls in community-dwelling OAs.

METHODS

A cross-sectional study involving 50 OAs aged over 60 years (average age of 72 years) was conducted. Participants underwent assessments of EF subdomains and PB using validated tests. A correlation analysis was employed to examine the relationships between EF and PB.

RESULTS

The study revealed significant correlations between subdomains and PB. Mental set shifting (r = -.539; p < .001) and inhibition (r = -.395; p = .050) exhibited inverse relationships with PB. Stepwise multiple linear regression showed that Trail Making Test Part B was associated with the PB (R2 = .42, p < .001).

CONCLUSION

These findings highlight the importance of assessing EF subdomains, particularly shifting and inhibition, to identify risk of falls. Trail Making Test Part B largely explains the variability of the PB. Integrating PB assessments and EF training, such as the Mini-BESTest, into routine care can be vital for fall prevention strategies. Significance/Implications: This knowledge underscores the need for cognitive training interventions focusing on shifting and inhibition to enhance PB and potentially reduce falls. Additionally, incorporation of EF assessment tools as Trail Making Test Part B and the Mini-BESTest into routine clinical practice for community-dwelling OAs is recommended to address fall prevention strategies.

Effects of nurse-led cognitive-motor dual-task training based on mobile health technology on the older adults with cognitive frailty: A quasi-experimental study

OBJECTIVE

To evaluate the feasibility and effect of nurse-led cognitive-motor dual-task training based on mobile health technology in people with cognitive frailty and investigate its potential for transforming practice in this population.

METHODS

From September 2021 to May 2022, a total of 74 older adults with cognitive frailty were screened at a Cognitive Memory Clinic of a tertiary hospital in Beijing. The control and intervention groups received health education related to cognitive frailty; additionally the intervention group received cognitive-motor dual-task training based on mobile health technology at home for 12 weeks, three times a week. At baseline (T0), post-intervention (T1) and one-year follow-up (T2), Montreal Cognitive Assessment-Peking version (MoCA-P), Fried Frailty phenotype (FP), Short Physical Performance Battery (SPPB), and Modified Fall Efficacy Scale (MFES) were employed to evaluate cognitive function, frailty, physical function, and fear of falling, and to assess the impact of cognitive-motor dual-task training on these measures.

RESULTS

The data collected for 65 out of 74 participants enrolled for the study was completed after 12 weeks intervention, including 34 participants in the control group and 31 participants in the intervention group. During the intervention, the majority (83.8 %) of the participants in the intervention group were able to complete the recommended intervention dose for 12 weeks under the guidance of nurses and the presence of caregivers. At the end of the 12-week intervention, the intervention group showed statistically significant improvements compared to the control in scores of MoCA-P (t=4.017, p<0.001), FP (t=3.739, p<0.001), MFES (t=4.283, p<0.001) and SPPB (t=3.548, p<0.001). At after one-year follow-up, the scores of MoCA-P (t=3.237, p<0.05), FP(t=3.725, p<0.001), and MFES (t=4.473, p<0.001) in the two groups remained statistically significant. Cognition, frailty and fear of falling were significantly affected by intergroup effects (Pgroup<0.05), time effects (Ptime<0.05) and interaction effects (Pgroup*time<0.001).

CONCLUSIONS

The cognitive-motor dual-task training program based on mobile health technology developed by nurses exhibited high feasibility and acceptability in older people with cognitive frailty. The intervention was found to significantly improve cognitive function, frailty, physical function, and fear of falling in older individuals with cognitive frailty, and showed a specific long-term maintenance effect. This study provides evidence for the promotion and application of mobile health technology, and serves as a practical basis for home health intervention for older individuals in the post-pandemic era.

The mitochondrial function of peripheral blood cells in cognitive frailty patients

Background

Cognitive frailty (CF), characterized by the coexistence of physical frailty and cognitive impairment, is linked to increased morbidity and mortality in older adults. While CF has been linked to multiple physiological and lifestyle factors, the underlying biological mechanisms remain poorly understood. This study investigated the risk factors for CF and explored the relationship between mitochondrial function and CF in hospitalized patients.

Methods

A total of 279 hospitalized individuals were recruited from December 2020 to August 2022, conducted comprehensive clinical assessments, and collected peripheral blood samples. CF was evaluated using the Physical Frailty Phenotype and Montreal Cognitive Assessment scales. Nutritional status was assessed with the Mini Nutritional Assessment, and depression was measured using the Geriatric Depression Scale. DNA was obtained from the peripheral blood and interrogated for mitochondrial DNA copy number (mtDNAcn). Peripheral blood mononuclear cells isolated from peripheral blood were examined for respiratory function and reactive oxygen species (ROS) levels. Additionally, plasma samples were analyzed for inflammatory markers and Carnitine Palmitoyltransferase II (CPT2).

Results

Among the participants, 90 were classified as CF and 46 as non-CF. Logistic regression analysis revealed that increased age (OR 1.156, 95% CI 1.064-1.255), lower educational attainment (OR 0.115, 95% CI 0.024-0.550), malnutrition (OR 0.713, 95% CI 0.522-0.973), and higher depression scores (OR 1.345, 95% CI 1.065-1.699) were significantly associated with CF. The independent t tests and Mann-Whitney U tests showed the CF group exhibited impaired mitochondrial function, characterized by reduced mtDNAcn and respiratory activity, coupled with elevated ROS, interleukin-6, and CPT2 levels compared with the non-CF group. After adjusted for age, sex, and BMI, compared with non-CF group, the OR values for the CF group of mtDNAcn and ROS were 0.234 (95% CI = 0.065-0.849) (p = 0.027) and 1.203 (95% CI = 1.075-1.347) (p = 0.001), respectively. The Sensitive analysis showed that the area under curve values for mtDNAcn and ROS were 0.653 and 0.925.

Conclusion

Age, lower educational attainment, malnutrition, and depression are significant risk factors for CF. Moreover, mitochondrial dysfunction, characterized by decreased mtDNAcn, impaired respiratory function and increased ROS levels appears to be a critical phenotype of CF.

The effectiveness of multicomponent exercise in older adults with cognitive frailty: a systematic review and meta-analysis

BACKGROUND

Cognitive frailty, intimately tied to adverse outcomes such as falls, early mortality, and hospitalization, represents a dynamic, reversible process. Multicomponent exercise has emerged as one of the most potent means of mitigating cognitive frailty.

AIMS

This research seeks to quantitively amalgamate the effects of multicomponent exercise on various domains: cognitive function, frailty status, and other health-related outcomes in cognitively frail older adults.

METHODS

Our methodology entailed a comprehensive review of literature in databases including PubMed, EMbase, CINAHL, Cochrane Library, Web of Science, Wanfang, Sinomed, VIP, and CNKI from the inception of these databases to December 10, 2023. For our statistical analysis, we utilized RevMan 5.3, Stata 17.0 and R 4.3.2 software. Adherence was maintained to the PRISMA checklist, with the study being registered with PROSPERO (CRD42024499808).

RESULTS

Our review encapsulated a total of 2,222 participants and 11 trials. The findings intimate that multicomponent exercise enhances cognitive function [MD = 2.52, p = 0.03]), grip strength[SMD = 0.39, p = 0.008] and lower limb muscle strength[MD = 4.30, p < 0.001], while alleviating frailty[MD = -2.21, p < 0.001] and depression [MD = -1.20, p = 0.001]. However, cogent evidence is still lacking to endorse the positive effects of multicomponent exercises on both ADL(p = 0.19) and quality of life(p = 0.16). Subgroup analyses revealed beneficial effects on cognitive frailty for multicomponent exercise whose type of exercise consisted of aerobic, the duration of which exceeded 120 min per week, and whose form of exercise was group exercise.

CONCLUSION

Multicomponent exercises offer significant improvements in cognitive function, muscle strength, and have the added benefit of reducing frailty and depression in older adults. However, these exercises do not appear to influence activities of daily living and quality of life positively.

Association of preoperative cognitive frailty with postoperative complications in older patients under general anesthesia: a prospective cohort study

BACKGROUND

Cognitive frailty (CF) is characterized by the coexistence of physical frailty and cognitive impairment, and it is associated with adverse health outcomes. Older adults are particularly vulnerable to CF due to factors such as age-related brain changes and the presence of comorbidities.

OBJECTIVE

To investigate the effect of preoperative CF on postoperative complications in older patients.

METHODS

This prospective cohort study was conducted among 253 patients aged 60-85 years, who underwent elective orthopedic and abdominal surgery (with a postoperative hospital stay of ≥ 3 days) at the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from May 2023 to November 2023. CF was assessed using the Montreal Cognitive Assessment (MoCA) for the cognitive status and the Fried criteria for five frailty scales. Participants were split into four groups: Group A (neither frailty nor cognitive impairment), Group B (frailty without cognitive impairment), Group C (cognitive impairment without frailty), and Group D (cognitive frailty). The primary outcome was postoperative complications, while secondary outcomes included mobility disability, prolonged hospital stay (PLOS), re-operation and 90-day readmission.

RESULTS

The median age (interquartile range) of participants was 69 (65-73) years, of which 40.3% were male. The prevalence of CF was 17.8%. The incidence of postoperative complications was 18.2% in Group A, 50.0% in Group B, 37.4% in Group C, and 75.6% in Group D. Multivariate analysis revealed that, compared to the control group (without cognitive impairment or frailty), patients with CF had a significantly higher risk of postoperative complications (OR, 12.86; 95%CI, 4.23-39.08). "Patients with frailty without cognitive impairment" had an increased risk (OR, 6.53; 95%CI, 2.04-20.9), while "those with cognitive impairment without frailty" also showed a higher risk (OR, 3.46; 95%CI, 1.57-7.64).

CONCLUSIONS

Cognitive frailty is significantly associated with an increased risk of postoperative adverse outcomes in older patients undergoing orthopedic and abdominal surgeries with general anesthesia. It indicates that clinicians should pay much attention to these older adults with CF.

Association Between Falls and Social Frailty in Community-Dwelling Older Japanese Adults

OBJECTIVES

This study aimed to investigate the association between falls and social frailty and its components among older Japanese adults.

METHODS

This is a cross-sectional study. Participants were categorized into 3 groups based on the number of falls in the past year: no fall (none), a single fall (occasional), and more than one fall (recurrent). The participants who met 2 or more of the following criteria were defined as socially frail: living alone, going out less frequently compared with the previous year, rarely visiting friends, feeling unhelpful to friends or family, and not talking with someone daily.

RESULTS

A total of 4,495 older Japanese adults living in a community analyzed in this study (51.0% women). Of the participants in this study, 3,851 (85.7%) were categorized as none, 443 (9.9%) as occasional, and 201 (4.5%) as recurrent. The proportion of participants considered socially frail was 11.5% in this study. Recurrent falls were associated with social frailty, even after adjusting for covariates (odds ratio [OR]: 1.49; 95% confidence interval [CI]: 1.01-2.19). The experience of recurrent falls was associated with the following components: "feeling unhelpful to friends and family" (OR: 1.62; 95% CI: 1.14-2.31) and "going outside less frequently compared with last year" (OR: 1.57; 95% CI: 1.06-2.31).

DISCUSSION

Among older Japanese adults, recurrent falls were associated with social frailty and with 2 of its components in particular: social roles and social participation. Future longitudinal studies should be conducted to gain insight into any causal relationships between these variables.

Construction and validation of a nomogram for predicting fear of falling related activity restrictions in community-dwelling older adults

Fear of falling related activity restrictions are widespread among older adults, leading to several adverse effects. Given these consequences, there is an urgent need for a comprehensive assessment tool that integrates various risk factors to predict the likelihood of older adults experiencing such activity restrictions. This cross-sectional study investigated fear of falling related activity restrictions and its influencing factors, simultaneously constructed and validated a nomogram among older adults residing in the communities in China. The model includes variables like age, gender, self-rated health, past year injurious falls, gait stability, anxiety, and cognitive impairment. It showed an AUC of 0.892. Internal validation had an AUC of 0.893, and external validation had an AUC of 0.939. Calibration curve showed good fit, and decision curve showed high clinical benefits. It's an intuitive tool for medical professionals to identify older adults at high risk of activity restrictions due to fear of falling.

Blind Spots in Hospital Fall Prevention: Falls in Stroke Patients Occurred Not Only in Those at a High Risk of Falling

OBJECTIVES

Although the standard falls prevention strategy is to identify and respond to patients with high-risk conditions, it remains unclear whether falls in patients with high fall risk account for most observed falls. In this study, fall risk and number of falls were calculated based on patients' motor and cognitive abilities, and the relationship between the two was examined.

DESIGN

We conducted a retrospective cohort study.

SETTING AND PARTICIPANTS

We included 2518 consecutive patients with stroke who were admitted to a rehabilitation hospital.

METHODS

Data on falls during hospitalization and biweekly assessed Functional Independence Measure scores were retrieved from the medical records. The average Functional Independence Measure scores for the motor and cognitive items were obtained and categorized as complete dependence, modified dependence, and independence. The fall rate (falls/1000 person-days) and number of observed falls in each combined condition were investigated.

RESULTS

Modified dependence on motor ability and complete dependence on cognitive ability had the highest risk of falls, with a fall rate of 10.8/1000 person-days and 51 fall observations, which accounted for 4.3% of all falls. Independent motor and cognitive ability had the lowest risk of falls, a fall rate of 2.6/1000 person-days and 146 observed falls, accounting for 12.4% of all falls, which was 2.8 times higher than the number of falls observed in the highest risk of falls condition.

CONCLUSIONS AND IMPLICATIONS

The combined motor-cognitive ability with the highest risk of falls in stroke inpatients did not have the highest number of observed falls. Rather, the combined motor-cognitive ability with the lowest risk of falls tended to have a high number of observed falls. A different strategy is needed to reduce the total number of falls.

Prognostic factors of first-ever stroke patients in suburban Malaysia by comparing regression models

<b>Introduction:</b> The aim of this study was to compare regression models based on the parameter estimates of prognostic factors of mortality in first-ever stroke patients.<br /> <b>Methods:</b> A retrospective study among 432 first-ever stroke patients admitted to Hospital Universiti Sains Malaysia, Kelantan, Malaysia, was carried out. Patient’s medical records were extracted using a standardized data collection sheet. The statistical analyses used for modelling the prognostic factors of mortality were Cox proportional hazards regression, multinomial logistic regression, and multiple logistic regression.<br /> <b>Results:</b> A total of 101 (23.4%) events of death were identified and 331 patients (76.6%) were alive. Despite using three different statistical analyses, the results were very similar in terms of five major aspects of parameter estimates, namely direction, estimation, precision, significance, and magnitude of risk assessment. It was reported slightly better in Cox proportional hazards regression model, especially in terms of the precision of the results.<br /> <b>Conclusions:</b> Given that this study had compared the findings from three different types of advanced statistical methods, this research has clearly yielded that with data of high quality, the selection of appropriate statistical method should not be a worrisome problem for researchers who may not be of expertise in the field of medical statistics.

Cross-Lagged Panel Analysis between Physical Frailty, Cognitive Function, and Falls by Sex

OBJECTIVES

This study investigated the reciprocal longitudinal relationships between physical frailty (PF), cognitive function (CF), and falls among community-dwelling older adults, according to sex. The study proposed hypotheses that present PF and CF will affect the occurrence of falls 2 years later.

DESIGN

Secondary data analysis using the first (T1, 2016-2017) and second (T2, 2018-2019) waves of the Korean Frailty and Aging Cohort Study (KFACS).

SETTING AND PARTICIPANTS

A total of 2318 community-dwelling older adults aged 70-84 years in South Korea; mean (SD) age: 75.72 (3.83) years; 47.7% men.

METHODS

PF and CF were measured with the modified version of the Fried Frailty Phenotype and the Korean version of the Mini-Mental State Examination, respectively. The number of falls were assessed. Multigroup cross-lagged panel analysis was used.

RESULTS

The results showed that relationships between PF, CF, and falls were maintained over time through an autoregressive effect. PF at T1 had a statistically significant longitudinal relationship with fall experience at T2 [standardized regression coefficient (β) = 0.087, 95% CI 0.045-0.129; P < .001], and fall experience at T1 had a significant longitudinal relationship with PF at T2 (β = 0.041, 95% CI 0.006-0.076; P = .020). There was no statistically significant relationship between CF and fall experience. PF and CF had statistically significant reciprocal longitudinal relationships (all P < .001). Based on sex, there was a statistically significant longitudinal relationship between fall experience at T1 and PF at T2 for men only (β = 0.063, 95% CI 0.012-0.114; P = .015).

CONCLUSIONS AND IMPLICATIONS

Findings highlight that health care providers should plan fall prevention programs through early intervention for PF improvement along with improvement and maintenance of CF. Specifically, even if older men are currently healthy and have a low risk of falls, it is important to prevent future fatal PF through prior interventions, such as risk activities attention and concerns about falls.

Long-Term Survival of Ischemic Stroke Patients according to Prior Cognitive Status: Dijon Stroke Registry

INTRODUCTION

Understanding the influence of preexisting cognitive impairment on the poststroke outcome is a critical challenge in the context of current aging and growing population. This study aimed to assess long-term survival of patients with acute ischemic stroke (IS) according to their premorbid cognitive status and to identify contributing factors of death.

METHODS

Patients with IS were prospectively identified among residents of Dijon, France, using a population-based registry (2013-2017). The association between case fatality at 5 years and prestroke cognitive status was assessed by multivariable Cox models adjusted for other clinical characteristics and preexisting brain damage on the initial CT scan including leukoaraiosis, old vascular brain lesions, and cortical and central brain atrophy, as well as major arterial occlusion.

RESULTS

1,049 patients were included (mean age ± SD: 76.3 ± 15.2 years old, 54% women). Case fatality rates at 5 years were 38.1% in patients without cognitive impairment, 65.9% in patients with prior mild cognitive impairment (MCI, n = 132, 12.6%), and 86.6% in patients with dementia (n = 164, 15.6%) (p < 0.001). MCI (HR = 1.39; 95% CI: 1.06-1.81, p = 0.016) and dementia (HR = 1.89; 95% CI: 1.45-2.46, p < 0.001) were both independently associated with higher case fatality after adjustment for clinical variables. The association remained significant after further adjustment for preexisting brain damage and major arterial occlusion (HR = 1.47; 95% CI: 1.10-1.98, p = 0.009, for MCI and HR = 1.90; 95% CI: 1.43-2.53, p < 0.001, for dementia) among patients with available data on the CT scan (n = 916). Factors associated with death were roughly similar across groups.

CONCLUSION

This study highlighted a poor long-term survival of IS patients with preexisting cognitive impairment, independently of other contributing factors of death. It is critical to better understand the trajectory of IS patients with preexisting cognitive impairment and to identify prognostic markers to guide clinicians in their management strategies.

Evaluation of Clinical Characteristics and CT Decision Rules in Elderly Patients with Minor Head Injury: A Prospective Multicenter Cohort Study

Age is variably described as a minor or major risk factor for traumatic intracranial lesions after head injury. However, at present, no specific CT decision rule is available for elderly patients with minor head injury (MHI). The aims of this prospective multicenter cohort study were to assess the performance of existing CT decision rules for elderly MHI patients and to compare the clinical and CT characteristics of elderly patients with the younger MHI population. Thirty-day mortality between two age groups (cutoff ≥ 60 years), along with clinical and CT characteristics, was evaluated with four CT decision rules: the National Institute for Health and Care Excellence (NICE) guideline, the Canadian CT Head Rule (CCHR), the New Orleans Criteria (NOC), and the CT Head Injury Patients (CHIP) rule. Of the 5517 MHI patients included, 2310 were aged ≥ 60 years. Elderly patients experienced loss of consciousness (17% vs. 32%) and posttraumatic amnesia (23% vs. 31%) less often, but intracranial lesions (13% vs. 10%), neurological deterioration (1.8% vs. 0.2%), and 30-day mortality (2.0% vs. 0.1%) were more frequent than in younger patients (all p < 0.001). Elderly patients with age as their only risk factor showed intracranial lesions in 5% (NOC and CHIP) to 8% (CCHR and NICE) of cases. The sensitivity of decision rules in the elderly patients was 60% (CCHR) to 97% (NOC) when age was excluded as a risk factor. Current risk factors considered when evaluating elderly patients show lower sensitivity to identify intracranial abnormalities, despite more frequent intracranial lesions. Until age-specific CT decision rules are developed, it is advisable to scan every elderly patient with an MHI.

Association between cognitive frailty and falls among older community dwellers in China: A Chinese longitudinal healthy longevity survey-based study

Background

The combined effect of cognitive impairment (CoI) and frailty on falls is controversial. This study aimed to explore whether older adults with cognitive frailty (CF) were at a higher risk of falls than those with only CoI or frailty and to present a fall prediction model based on CF.

Methods

A total of 4,067 adults aged ≥ 60 years were included from the Chinese Longitudinal Healthy Longevity Survey through face-to-face interviews. Cognitive function and frailty were assessed using the mini-mental state examination scale and frailty index, respectively. Logistic regression was used to determine fall-associated risk factors and develop a fall prediction model. A nomogram was then plotted. The model performance was evaluated using the area under the curve (AUC), concordance index (C-index), and calibration curve. All analyses were performed using SPSS and R statistical packages.

Results

The prevalence of CF and falls were 1.4 and 19.4%, respectively. After adjusting for covariates, the odds ratio of CF, frailty only, and CoI only for falls were 2.27 (95% CI: 1.29-3.97), 1.41 (95% CI: 1.16-1.73), and 0.99 (95% CI: 0.43-2.29), respectively. CF, sex, age, hearing difficulty, depression, anxiety, disability in instrumental activities of daily living, and serious illness in the past 2 years were independently associated with falls. A prediction model based on these factors yielded an AUC of 0.646 and a C-index of 0.641.

Conclusion

Cognitive frailty (CF) exerted a cumulative effect on falls than did CoI or frailty alone. Joint assessments of cognitive function and frailty status may be beneficial for fall risk screening in community. A prediction model using CF as a factor could be helpful for this process.