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

Published online by Cambridge University Press:  13 November 2018

Judith Godin
Geriatric Medicine Research, Division of Geriatric Medicine, Nova Scotia Health Authority and Dalhousie University, Nova Scotia, Canada
Joshua J. Armstrong
Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
Lindsay Wallace
Geriatric Medicine Research, Division of Geriatric Medicine, Nova Scotia Health Authority and Dalhousie University, Nova Scotia, Canada
Kenneth Rockwood
Geriatric Medicine Research, Division of Geriatric Medicine, Nova Scotia Health Authority and Dalhousie University, Nova Scotia, Canada
Melissa K. Andrew*
Geriatric Medicine Research, Division of Geriatric Medicine, Nova Scotia Health Authority and Dalhousie University, Nova Scotia, Canada
Correspondence should be addressed to: Melissa K. Andrew, c/o Division of Geriatric Medicine, Veterans’ Memorial Building, 5955 Veterans’ Memorial Lane, Halifax, NS B3H 2E1, Canada. Phone: (902) 473-4995; Fax: (902) 473-7133. Email:



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.


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.


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).


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.

Original Research Article
© International Psychogeriatric Association 2018 

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