Publication Date


Document Type

Doctoral Dissertation

Academic Program

Clinical and Population Health Research


Population and Quantitative Health Sciences

First Thesis Advisor

Kate L. Lapane


Physical frailty, Cognitive impairment, Nursing home, Latent class analysis, Group-based trajectory modeling



For the 1.2 million older adults residing in U.S. nursing homes, little is known about their experience with physical frailty and cognitive impairment, two critical interrelated aging conditions.


Minimum Data Set 3.0 was used. Physical frailty was measured by FRAIL-NH and cognitive impairment by Brief Interview for Mental Status and Cognitive Performance Scale. Demographic and clinical characteristics were adjusted accordingly. Aim 1 described the prevalence of physical frailty and cognitive impairment and longitudinally examined the association between two conditions with the non-proportional odds model. Aim 2 used latent class analysis to identify physical frailty subgroups and estimated their association with cognitive impairment using multinomial logistic regression. Aim 3 fitted group-based trajectory models to identify physical frailty trajectories and cognitive impairment trajectories and quantified the association between the two sets of trajectories.

Main Results

Around 60% of older residents were physically frail and 68% had moderate/severe cognitive impairment, with improvement and worsening observed in both conditions, particularly in the first three months. Older residents with moderate/severe cognitive impairment were consistently and increasingly more likely to be frail.

Three physical frailty subgroups were identified at admission. Greater cognitive impairment was associated with higher odds to belong to “severe physical frailty”.

Five physical frailty trajectories and three cognitive impairment trajectories were identified over the first six months. One in five older residents were “Consistently Frail” and “Consistently Severe Cognitive Impairment”.


Findings emphasized the need for care management tailored to the heterogeneous presentations and progression trajectories of physical frailty and cognitive impairment.



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Available for download on Wednesday, March 29, 2023

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