Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Royal College of Surgeons in Ireland and University College Dublin Malaysia Campus (RCSI & UCD), Penang, Malaysia.
Psychogeriatrics. 2023 Nov;23(6):1071-1082. doi: 10.1111/psyg.13031. Epub 2023 Sep 26.
Cognitive frailty describes the co-occurrence of cognitive impairment and physical frailty and is classified into reversible and irreversible phenotypes. Data on the impact of COVID-19 pandemic imposed lockdowns, locally known as the Movement Control Order (MCO), on the psychological status of cognitively frail older adults remain scarce. Therefore, this study aimed to determine the relationship between depression, anxiety, stress and cognitive frailty among older adults during the MCO.
Participants aged above 60 years from three ageing cohorts in Malaysia were interviewed virtually. The Fatigue, Resistance, Ambulation, Illness and Loss of Weight scale, blind Montreal Cognitive Assessment, 15-item Geriatric Depression Scale, anxiety subscale of Depression, Anxiety and Stress Scale and four-item Perceived Stress Scale measured frailty, mild cognitive impairment (MCI), depression, anxiety and stress, respectively.
Cognitive frailty data were available for 870 participants, age (mean ± SD) = 73.44 ± 6.32 years and 55.6% were women. Fifty-seven (6.6%) were robust, 24 (2.8%) had MCI, 451 (51.8%) were pre-frail, 164 (18.9%) were pre-frail+MCI, 119 (13.7%) were frail and 55 (6.3%) were frail+MCI. There were significant differences in depression and anxiety scores between the controlled MCO and recovery MCO. Using multinomial logistic regression, pre-frail (mean difference (95% confidence interval, CI) = 1.16 (0.932, 1.337), frail (1.49 (1.235, 1.803) and frail+MCI (1.49 (1.225, 1.822)) groups had significantly higher depression scores, frail (1.19 (1.030, 1.373)) and frail+MCI (1.24 (1.065, 1.439)) had significantly higher anxiety scores and pre-frail (1.50 (1.285, 1.761)), frail (1.74 (1.469, 2.062)) and frail+MCI (1.81 (1.508, 2.165)) had significantly higher stress scores upon adjustments for the potential confounders. The MCO was a potential confounder in the relationship between depression and prefrail+MCI (1.08 (0.898, 1.340)).
Frail individuals with or without MCI had significantly higher depression, anxiety and stress than those who were robust. Increased depression and stress were also observed in the pre-frail group. Interventions to address psychological issues in older adults during the COVID-19 pandemic could target prefrail and frail individuals and need further evaluation.
认知脆弱描述了认知障碍和身体脆弱的同时发生，并分为可逆和不可逆表型。关于 COVID-19 大流行期间实施的封锁（本地称为行动管制令）对认知脆弱的老年人心理健康的影响的数据仍然很少。因此，本研究旨在确定行动管制令期间认知脆弱的老年人的抑郁、焦虑、压力和认知脆弱之间的关系。
来自马来西亚三个老龄化队列的 60 岁以上的参与者进行了虚拟访谈。疲劳、抵抗力、活动能力、疾病和体重减轻量表、盲蒙特利尔认知评估、15 项老年抑郁量表、抑郁焦虑和压力量表的焦虑子量表和四项感知压力量表分别测量了脆弱性、轻度认知障碍（MCI）、抑郁、焦虑和压力。
认知脆弱性数据可用于 870 名参与者，年龄（平均值±标准差）=73.44±6.32 岁，55.6%为女性。57 人（6.6%）为稳健，24 人（2.8%）为 MCI，451 人（51.8%）为脆弱前期，164 人（18.9%）为脆弱前期+MCI，119 人（13.7%）为脆弱，55 人（6.3%）为脆弱+MCI。在控制的行动管制令和恢复的行动管制令之间，抑郁和焦虑评分存在显著差异。使用多项逻辑回归，脆弱前期（平均差异（95%置信区间，CI）=1.16（0.932，1.337），脆弱（1.49（1.235，1.803）和脆弱+MCI（1.49（1.225，1.822））组的抑郁评分显著更高，脆弱（1.19（1.030，1.373））和脆弱+MCI（1.24（1.065，1.439））的焦虑评分显著更高，脆弱前期（1.50（1.285，1.761））、脆弱（1.74（1.469，2.062））和脆弱+MCI（1.81（1.508，2.165））的压力评分显著更高。在调整潜在混杂因素后，脆弱前期（1.50（1.285，1.761））、脆弱（1.74（1.469，2.062））和脆弱+MCI（1.81（1.508，2.165））的 MCO 是抑郁和脆弱前期+MCI（1.08（0.898，1.340））之间关系的潜在混杂因素。
有或没有 MCI 的脆弱个体的抑郁、焦虑和压力明显高于稳健个体。脆弱前期组也观察到抑郁和压力增加。在 COVID-19 大流行期间，针对老年人心理健康问题的干预措施可以针对脆弱前期和脆弱个体，并需要进一步评估。
