Introduction:
Puerto Rico is undergoing a rapid demographic transition, with adults aged 60 and older comprising nearly one-third of the total population (29.6% in 2023). Studies have shown the importance of examining clinically relevant indicators of vulnerability to support healthy aging among older adults, especially those lacking familial support networks. Little is known about the effects of cognitive frailty on late-life mortality in Caribbean older adults. This construct provides a multidimensional perspective for understanding mortality risk in late-life.
Purpose:
This study examined whether cognitive functioning and physical frailty independently predict mortality among older adults in Puerto Rico.
Method:
Data were derived from the Puerto Rican Elderly Health Conditions (PREHCO) longitudinal study. The analytic sample included 2,330 community-dwelling adults aged 60 years or older (mean age = 74.13; SD=7.30, 60.6% female). Cognitive functioning was assessed using the Mini-Mental Cabán, a culturally validated cognitive screening tool, and physical frailty was measured using the Modified Frailty Index (mFI-5), with higher scores indicating greater frailty. Cox proportional hazards regression models were estimated controlling for age, gender, and years of education.
Results:
Higher cognitive functioning significantly predicted reduced mortality risk (HR = 0.944; 95% CI: 0.923-0.966), representing a 5.6% decrease per additional point on the Mini-Mental Cabán. Conversely, greater frailty was associated with an increased risk of mortality (HR = 1.224; 95% CI: 1.166-1.285), representing a 22.4% higher mortality risk per unit increase in the frailty index. Both associations remained significant after covariate adjustment, supporting the conceptual validity of cognitive frailty as a clinically meaningful construct in aging populations.
Conclusions:
Cognitive and physical frailty independently predict mortality in older Puerto Rican adults. Incorporating cognitive frailty screening into primary care could enhance early detection of vulnerability and guide personalized interventions that promote resilience and healthy aging in culturally diverse populations.