Combined associations of cognitive impairment and psychological resilience with all-cause mortality in community-dwelling older adults

• Published in: Journal of affective disorders Vol. 351; pp. 962 - 970
• Main Authors: Zhang, Chi, Liu, Ye, Zeng, Lvtao, Luo, Xuanmei, Fan, Guoqing, Shi, Hong, Shen, Ji
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15-04-2024
• Subjects: Aged; All-cause mortality; Cognition; Cognitive Dysfunction - psychology; Cognitive impairment; Female; Humans; Independent Living - psychology; Longevity; Male; Older adults; Psychological resilience; Resilience, Psychological; All-cause mortality; Psychological resilience; Older adults; Cognitive impairment
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2024.02.015

Cognitive impairment and psychological resilience are closely related in older adults, but their combined effect on mortality has not been reported. Using a nationally representative sample from the Chinese Longitudinal Healthy Longevity Study, this study examined the interactions between cognitive impairment and psychological resilience and their associations with overall survival.
A total of 32,349 community-dwelling older adults (86.85 ± 11.16 years, 56.06 % female) were enrolled in 1998, 2000, 2002, 2005, 2008, 2011, and 2014; all participants were followed until 2018. Cognitive function and psychological resilience were assessed using the Mini-Mental State Examination (MMSE) and the 7-item psychological resilience questionnaire (PRQ), respectively. Illiterate subjects with an MMSE score <18, or literate subjects with an MMSE score <24 were defined as having cognitive impairment. Cox proportional risk regressions were used to analyze the association of cognitive impairment and psychological resilience with all-cause mortality.
After 146,993.52 person-years of follow-up, 23,349 older adults died. Both MMSE and PRQ scores (as continuous variables) were negatively associated with mortality risk after adjusting for all covariates. The hazard ratio (HR) of all-cause mortality for cognitive impairment was not significantly moderated by levels of psychological resilience (P-interaction = 0.094). In joint analyses, participants with combined cognitive impairment and low resilience (by the median of PRQ: < 25 points) had the highest risk of mortality (adjusted-HR: 1.56, 95%CI: 1.48–1.61), which was higher than that of patients with either condition alone. There was a significant additive interaction effect of cognitive impairment and low resilience on all-cause mortality (relative excess risk due to interaction: 0.11, 95 % CI: 0.09–0.13), and 7 % of the overall mortality risk was attributable to their synergistic effect.
Cognitive impairment and low resilience are synergistically associated with increased risk of all-cause mortality in community-dwelling older adults. The potential mechanisms underlying this combined effect warrant further exploration.
•Both cognitive function and psychological resilience were associated with all-cause mortality in older adults.•We observed a significant additive interaction between cognitive impairment and low resilience on all-cause mortality.•Combining screening and targeting psychological interventions could be useful for community-dwelling older people.