The impact of frailty and cognitive impairment on quality of life: employment and social context matter

Background: How cognitive impairment and frailty combine to impact on older adults' Quality of Life (QoL) is little studied, but their inter-relationships are important given how often they co-occur. We sought to examine how frailty and cognitive impairment, as well as changes in frailty and cognition, are associated with QoL and how these relationships differ based on employment status and social circumstances. Methods: Using the Survey of Health, Ageing, and Retirement in Europe data, we employed moderated regression, followed by simple slopes analysis, to examine how the relationships between levels of health (i.e., of frailty and cognition) and QoL varied as a function of sex, age, education, social vulnerability, and employment status. We used the same analysis to test whether the relationships between changes in health (over two years) and QoL varied based on these same moderators. Results: Worse frailty (b = -1.61, p < .001) and cognitive impairment (b = -0.08, p < .05) were each associated with lower QoL. Increase in frailty (b = -2.17, p < .001) and cognitive impairment (b = -0.25, p < .001) were associated with lower QoL. The strength of these relationships varied depending on interactions with age, sex, education, social vulnerability, and employment status. Higher social vulnerability was consistently associated with lower QoL in analyses examining both static health (b = -3.16, p < .001) and change in health (b = -0.66, p < .001). Conclusions: Many predictors of QoL are modifiable, providing potential targets to improve older adults' QoL. Even so, the relationships between health, cognition, and social circumstances that shape QoL in older adults are complex, highlighting the importance for individualized interventions.