Self-Rated Health, Leisure Activities and Cognitive Frailty Among Community-Dwelling Older Adults

OBJECTIVES: Self-rated health is predictive of frailty, cognitive impairment, suggesting it may also predict cognitive frailty, although the mechanism involving leisure activities has not been empirically examined. To identify the association between self-rated health and cognitive frailty, and leisure activities as a mediator and its interaction with self-rated health on cognitive frailty. METHODS: A total of 3434 participants aged 60 or older were recruited in 2011 and followed up in 2015 from the China Health and Retirement Longitudinal Study . Cognitive frailty was assessed through the coexistence of frailty (Fried) and mild cognitive impairment (cognitive tests), excluding concurrent dementia. RESULTS: Self-rated poor health increased the risk of cognitive frailty (OR = 2.02 [95% CI: 1.58, 2.60]). Leisure activities nonparticipation (estimate = 0.081 [95% CI: 0.01, 0.18]) mediated the association between self-rated health and cognitive frailty. Older adults with both self-rated poor health and leisure activities nonparticipation (OR = 2.97 [95% CI: 2.12, 4.16]) had a higher risk of cognitive frailty than those with self-rated poor health (OR = 1.67 [95% CI: 1.12, 2.47]) or leisure activities nonparticipation (OR = 1.30 [95% CI: 0.94, 1.80]) alone. The relative excess risk of interaction, the attributable proportion due to interaction, were 1.00 (95% CI: 0.14, 1.86) and 0.34 (95% CI: 0.09, 0.59), respectively. CONCLUSIONS: Self-rated health predicted cognitive frailty, mediated by leisure activities, and has additive interactions with leisure activities, suggesting it as a screening tool to identify older adults at high risk of cognitive frailty and emphasising early interventions that particularly motivate their intention to participate in leisure activities.