Cognitive frailty in older adults with diabetes: prevalence and risk factors
In older adults living with diabetes, there is a higher prevalence of frailty and a greater risk of cognitive impairment. Cognitive frailty is defined by the presence of both and is associated with an increased risk of mortality. A systematic review was undertaken to estimate the prevalence of cognitive frailty in community-dwelling older adults living with diabetes and associated risk factors. This commentary critically appraises the review and explores the implications of the findings for community practice.
In the UK, 4.3 million people live with diabetes, while a further 850 000 could be living with the condition and be unaware of it (Diabetes UK, 2023). Type 2 diabetes mellitus is a chronic metabolic disorder, characterised by hyperglycaemia, and is associated with greater risks of heart disease, stroke, peripheral neuropathy, renal disease, blindness and amputation (Hurtado and Vella, 2019). Middle-aged and older adults with diabetes have a higher prevalence of frailty (Hanlon et al, 2018), an increased vulnerability associated with ageing, and experience a decline in the body's physical and psychological reserves (Turner, 2014). Both diabetes and frailty are independently associated with low self-rated health, depressive symptoms and low quality of life (O'Donovan et al, 2021).
In addition to physical frailty, cognitive impairment is increasingly recognised as a potential complication of diabetes, which may reflect a direct effect on the brain of hyperglycaemia or the effects of associated comorbidities such as hypertension (Luchsinger et al, 2018). Diabetes that is poorly controlled in older adults is also associated with double the risk of cognitive impairment no dementia (CIND) and triple the risk of CIND progressing to dementia (Dove et al, 2021).
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