Relationships between physical frailty, depressive symptoms, and cognitive ability among community-dwelling older adults in India
Abstract Background With a rapidly aging population, physical frailty has become a significant public health concern globally. While the association between frailty, depression, and cognitive decline has been widely studied in developed countries, there is limited evidence from low- and middle-incom...
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2025-07-01
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| author | T. Muhammad Manish Kumar Shobhit Srivastava Waad Ali |
| author_facet | T. Muhammad Manish Kumar Shobhit Srivastava Waad Ali |
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| description | Abstract Background With a rapidly aging population, physical frailty has become a significant public health concern globally. While the association between frailty, depression, and cognitive decline has been widely studied in developed countries, there is limited evidence from low- and middle-income countries, including India. Additionally, little is known about the sex-specific associations between frailty, and mental and cognitive health outcomes. We examined the associations of physical frailty with depressive symptoms and cognitive functioning among older Indian men and women, while also exploring how the frailty-cognition link differs between those with and without depression. Methods We used data from the Longitudinal Aging Study in India, conducted between 2017 and 2019. The analytic sample consisted of 14,652 males and 15,899 females aged ≥ 60 years. Frailty was assessed using a modified version of Fried’s frailty phenotype, depressive symptoms were evaluated using the Composite International Diagnostic Interview- Short Form, and cognitive ability was measured through memory, orientation, arithmetic, executive function, and object naming tasks. Univariate and multivariable linear regression models were used to examine the associations between frailty, depressive symptoms, and cognitive ability in older men and women, as well as frailty-cognition association by depressive status. Results The prevalence of frailty was higher in older women than that in older men (32.2% vs. 27.4%). The mean depressive symptom score was higher (0.8 vs 1.0), and the mean cognitive score was lower (26.4 vs 22.1) among older women than men. Physical frailty was associated with higher levels of depressive symptoms (β = 0.51; 95% CI: 0.39, 0.64), and poor cognitive performance (β = -1.06; 95% CI: -1.37, -0.75). Non-frail older men had lower depressive symptoms than frail older men (β = -0.48; 95% CI: -0.66, -0.31), however, the association was not significant among older women. Furthermore, frail older women performed worse on cognitive tests than did frail older men (β = -2.14; 95% CI: -2.40, -1.87). In addition, non-frail older women had poorer cognitive performance than frail older men (β = -0.77; 95% CI: -1.22, -0.32). Conversely, stratification by depressive status showed that frailty was associated with worse cognitive ability, with no difference between individuals with and without depression. Conclusions We found that frail older individuals, particularly women, have significant mental and cognitive deficits compared with their non-frail counterparts. Our findings have major implications in both community and clinical settings. Appropriate policies and programs should be implemented to reinforce the strength of pre-frail and frail older adults and maintain improved mental health and cognition in older adults. |
| format | Article |
| id | doaj-art-021bb496f0b6487984352d7a94069cf8 |
| institution | Kabale University |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-07-01 |
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| spelling | doaj-art-021bb496f0b6487984352d7a94069cf82025-08-20T04:01:42ZengBMCBMC Public Health1471-24582025-07-0125111610.1186/s12889-025-23197-yRelationships between physical frailty, depressive symptoms, and cognitive ability among community-dwelling older adults in IndiaT. Muhammad0Manish Kumar1Shobhit Srivastava2Waad Ali3Center for Healthy Aging, Department of Human Development and Family Studies, Pennsylvania State UniversityInternational Institute for Population SciencesInternational Institute for Population SciencesDepartment of Geography, Sultan Qaboos UniversityAbstract Background With a rapidly aging population, physical frailty has become a significant public health concern globally. While the association between frailty, depression, and cognitive decline has been widely studied in developed countries, there is limited evidence from low- and middle-income countries, including India. Additionally, little is known about the sex-specific associations between frailty, and mental and cognitive health outcomes. We examined the associations of physical frailty with depressive symptoms and cognitive functioning among older Indian men and women, while also exploring how the frailty-cognition link differs between those with and without depression. Methods We used data from the Longitudinal Aging Study in India, conducted between 2017 and 2019. The analytic sample consisted of 14,652 males and 15,899 females aged ≥ 60 years. Frailty was assessed using a modified version of Fried’s frailty phenotype, depressive symptoms were evaluated using the Composite International Diagnostic Interview- Short Form, and cognitive ability was measured through memory, orientation, arithmetic, executive function, and object naming tasks. Univariate and multivariable linear regression models were used to examine the associations between frailty, depressive symptoms, and cognitive ability in older men and women, as well as frailty-cognition association by depressive status. Results The prevalence of frailty was higher in older women than that in older men (32.2% vs. 27.4%). The mean depressive symptom score was higher (0.8 vs 1.0), and the mean cognitive score was lower (26.4 vs 22.1) among older women than men. Physical frailty was associated with higher levels of depressive symptoms (β = 0.51; 95% CI: 0.39, 0.64), and poor cognitive performance (β = -1.06; 95% CI: -1.37, -0.75). Non-frail older men had lower depressive symptoms than frail older men (β = -0.48; 95% CI: -0.66, -0.31), however, the association was not significant among older women. Furthermore, frail older women performed worse on cognitive tests than did frail older men (β = -2.14; 95% CI: -2.40, -1.87). In addition, non-frail older women had poorer cognitive performance than frail older men (β = -0.77; 95% CI: -1.22, -0.32). Conversely, stratification by depressive status showed that frailty was associated with worse cognitive ability, with no difference between individuals with and without depression. Conclusions We found that frail older individuals, particularly women, have significant mental and cognitive deficits compared with their non-frail counterparts. Our findings have major implications in both community and clinical settings. Appropriate policies and programs should be implemented to reinforce the strength of pre-frail and frail older adults and maintain improved mental health and cognition in older adults.https://doi.org/10.1186/s12889-025-23197-yPhysical frailtyDepressive symptomsCognitive abilityOlder adultsIndia |
| spellingShingle | T. Muhammad Manish Kumar Shobhit Srivastava Waad Ali Relationships between physical frailty, depressive symptoms, and cognitive ability among community-dwelling older adults in India BMC Public Health Physical frailty Depressive symptoms Cognitive ability Older adults India |
| title | Relationships between physical frailty, depressive symptoms, and cognitive ability among community-dwelling older adults in India |
| title_full | Relationships between physical frailty, depressive symptoms, and cognitive ability among community-dwelling older adults in India |
| title_fullStr | Relationships between physical frailty, depressive symptoms, and cognitive ability among community-dwelling older adults in India |
| title_full_unstemmed | Relationships between physical frailty, depressive symptoms, and cognitive ability among community-dwelling older adults in India |
| title_short | Relationships between physical frailty, depressive symptoms, and cognitive ability among community-dwelling older adults in India |
| title_sort | relationships between physical frailty depressive symptoms and cognitive ability among community dwelling older adults in india |
| topic | Physical frailty Depressive symptoms Cognitive ability Older adults India |
| url | https://doi.org/10.1186/s12889-025-23197-y |
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