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Background <p>Falls are one of the leading causes of disability and mortality in older adults. Frailty and cognitive impairment are recognized as key risk factors, but their joint impact on fall risk and the underlying association remain unclear.</p> Methods <p>This study utilized data from the China Health and Retirement Longitudinal Study, with a 7-year follow-up period (2011–2018). The study included 6,274 participants aged ≥ 60 years. Follow-up surveys were conducted at approximately 2-year intervals to assess the incidence of falls.Frailty was assessed using a modified physical frailty phenotype, and cognitive function was measured with standardized memory and executive function tests. Logistic regression, moderation, and mediation models were applied to examine the independent and interactive effects of frailty and cognitive impairment on falls, with multivariable adjustment for demographic, behavioral, and clinical factors.</p> Results <p>During the 7-year follow-up, 19.4% of participants reported at least one fall. Frailty was independently associated with increased fall risk (OR 2.06, 95% CI 1.35–3.12), as was cognitive impairment (OR 1.48, 95% CI 1.27–1.71). Moderation analysis showed a significant interaction, indicating that cognitive impairment amplified the association between frailty and falls (P for interaction &lt; 0.001). Mediation analysis further revealed that cognitive impairment partially mediated the frailty–falls association, accounting for 49.4% of the total effect. These associations were consistent across demographic subgroups and robust to sensitivity analyses.</p> Conclusion <p>This study provides longitudinal evidence that frailty and cognitive impairment synergistically increase the risk of falls in older adults through both moderation and mediation pathways. In this longitudinal cohort of older Chinese adults, our findings suggest that frailty and cognitive impairment may jointly increase fall risk, with evidence of both statistical moderation and mediation.</p> <p>These findings highlight the importance of jointly assessing frailty and cognition in fall prevention and suggest that targeted interventions in cognitively frail populations may yield greater benefits.</p>

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Associations of frailty and cognitive impairment with fall risk in older adults: a longitudinal cohort study based on CHARLS

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月16日

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  • Kai Zhou,
  • Boyuan Shi,
  • Fangye Shi,
  • Lei Chen,
  • Jiandong Yuan,
  • Zhiqiang Xue

摘要

Background

Falls are one of the leading causes of disability and mortality in older adults. Frailty and cognitive impairment are recognized as key risk factors, but their joint impact on fall risk and the underlying association remain unclear.

Methods

This study utilized data from the China Health and Retirement Longitudinal Study, with a 7-year follow-up period (2011–2018). The study included 6,274 participants aged ≥ 60 years. Follow-up surveys were conducted at approximately 2-year intervals to assess the incidence of falls.Frailty was assessed using a modified physical frailty phenotype, and cognitive function was measured with standardized memory and executive function tests. Logistic regression, moderation, and mediation models were applied to examine the independent and interactive effects of frailty and cognitive impairment on falls, with multivariable adjustment for demographic, behavioral, and clinical factors.

Results

During the 7-year follow-up, 19.4% of participants reported at least one fall. Frailty was independently associated with increased fall risk (OR 2.06, 95% CI 1.35–3.12), as was cognitive impairment (OR 1.48, 95% CI 1.27–1.71). Moderation analysis showed a significant interaction, indicating that cognitive impairment amplified the association between frailty and falls (P for interaction < 0.001). Mediation analysis further revealed that cognitive impairment partially mediated the frailty–falls association, accounting for 49.4% of the total effect. These associations were consistent across demographic subgroups and robust to sensitivity analyses.

Conclusion

This study provides longitudinal evidence that frailty and cognitive impairment synergistically increase the risk of falls in older adults through both moderation and mediation pathways. In this longitudinal cohort of older Chinese adults, our findings suggest that frailty and cognitive impairment may jointly increase fall risk, with evidence of both statistical moderation and mediation.

These findings highlight the importance of jointly assessing frailty and cognition in fall prevention and suggest that targeted interventions in cognitively frail populations may yield greater benefits.