Frontiers in public health · 2026
A study on the correlation between frailty, sleep quality, and cognitive function in low-income older adults living in the urban-rural fringe of China.
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Huang Chicheng, Zhou Zijian, Yu Jingman, Ma Xin, Yu Zhikai, Wang Changming
Аннотация
OBJECTIVE: This cross-sectional study aims to explore the independent and combined effects of physical frailty and sleep quality on cognitive function in low-income older adults in the urban-rural fringe of China, and to examine whether daily activities (ADL) play a mediating role between frailty and cognitive function.
METHODS: A combination of convenience sampling and stratified sampling was used to recruit 198 people over 55 and above from a community in the urban-rural fringe of Keerqin District, Tongliao City, Inner Mongolia. Cognitive function was assessed using the Montreal Cognitive Assessment Beijing version (MoCA BJ), frailty was assessed using the FRAIL scale, sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), depressive symptoms were assessed using the 15-item version of the Geriatric Depression Scale (GDS-15), and daily functioning was assessed using the ADL scale. Covariates included age, sex, years of education, smoking status, alcohol consumption, and number of chronic diseases. The statistical methods include hierarchical multiple linear regression and Bootstrap mediation analysis (resampling 2,000 times).
RESULTS: 48.5% of participants in the sample had cognitive impairment (MoCA<18 points), and 65.2% reported poor sleep quality (PSQI ≥ 5 points). One-way ANOVA showed significant differences in MoCA scores among the three groups of frailty grades (F = 7.26, p < 0.001, η 2 = 0.069), with the frailty group scoring significantly lower than the robust group (Bonferroni adjusted p = 0.001). Hierarchical regression analysis (Model 4, R2 = 0.254) showed that the PSQI total score (B = -0.78, p = 0.016) and ADL score (B = 0.85, p = 0.010) were independent predictors of MoCA, while the health and lifestyle covariates (smoking, alcohol, chronic disease count) were non-significant. Bootstrap mediation analysis showed that ADL function exhibited a significant mediation effect in the frailty-cognition association (indirect effect = -0.42, 95% CI [-0.80, -0.14]), accounting for 45.4% of the total effect; however, after controlling for lifestyle and comorbidity covariates, this mediation effect was not statistically significant (indirect effect = -0.19, 95% CI [-0.40, 0.03], p = 0.092). The sleep-depression-cognition pathway did not reach statistical significance.
CONCLUSION: Frailty and sleep quality (especially sleep latency) are independently correlated with cognitive function. Daily functional impairment shows a significant mediation trend in the frailty-cognition association, and this effect only reaches marginal significance after controlling for chronic disease burden and lifestyle factors. This suggests that comprehensive interventions addressing multimorbidity may be more fundamental than simple daily functional rehabilitation. Therefore, on the basis of systematic management of multiple chronic diseases, combining interventions aimed at improving sleep difficulties and maintaining physical functional independence can provide practical entry points for promoting cognitive health in this vulnerable group.
METHODS: A combination of convenience sampling and stratified sampling was used to recruit 198 people over 55 and above from a community in the urban-rural fringe of Keerqin District, Tongliao City, Inner Mongolia. Cognitive function was assessed using the Montreal Cognitive Assessment Beijing version (MoCA BJ), frailty was assessed using the FRAIL scale, sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), depressive symptoms were assessed using the 15-item version of the Geriatric Depression Scale (GDS-15), and daily functioning was assessed using the ADL scale. Covariates included age, sex, years of education, smoking status, alcohol consumption, and number of chronic diseases. The statistical methods include hierarchical multiple linear regression and Bootstrap mediation analysis (resampling 2,000 times).
RESULTS: 48.5% of participants in the sample had cognitive impairment (MoCA<18 points), and 65.2% reported poor sleep quality (PSQI ≥ 5 points). One-way ANOVA showed significant differences in MoCA scores among the three groups of frailty grades (F = 7.26, p < 0.001, η 2 = 0.069), with the frailty group scoring significantly lower than the robust group (Bonferroni adjusted p = 0.001). Hierarchical regression analysis (Model 4, R2 = 0.254) showed that the PSQI total score (B = -0.78, p = 0.016) and ADL score (B = 0.85, p = 0.010) were independent predictors of MoCA, while the health and lifestyle covariates (smoking, alcohol, chronic disease count) were non-significant. Bootstrap mediation analysis showed that ADL function exhibited a significant mediation effect in the frailty-cognition association (indirect effect = -0.42, 95% CI [-0.80, -0.14]), accounting for 45.4% of the total effect; however, after controlling for lifestyle and comorbidity covariates, this mediation effect was not statistically significant (indirect effect = -0.19, 95% CI [-0.40, 0.03], p = 0.092). The sleep-depression-cognition pathway did not reach statistical significance.
CONCLUSION: Frailty and sleep quality (especially sleep latency) are independently correlated with cognitive function. Daily functional impairment shows a significant mediation trend in the frailty-cognition association, and this effect only reaches marginal significance after controlling for chronic disease burden and lifestyle factors. This suggests that comprehensive interventions addressing multimorbidity may be more fundamental than simple daily functional rehabilitation. Therefore, on the basis of systematic management of multiple chronic diseases, combining interventions aimed at improving sleep difficulties and maintaining physical functional independence can provide practical entry points for promoting cognitive health in this vulnerable group.