b ain
sciences
A icle
P e alence o Cogni i e F ail y,
Do Psychosocial-Rela ed Fac o s Ma e ?
Espe anza Na a o-Pa do 1,†, Da id Facal 2,*,†, Ma ía Campos-Magdaleno 2,
A u o X. Pe ei o 2and Onésimo Juncos-Rabadán2
1
Depa men o De elopmen al and Educa ional Psychology, Uni e si a de Valencia, 46010 Valencia, Spain;
Espe anza.Na a o@u .es
2Depa men o De elopmen al Psychology, Uni e si y o San iago de Compos ela,
15782 San iago de Compos ela, Spain; [email p o ec ed] (M.C.-M.); a u oxose.pe [email p o ec ed] (A.X.P.);
[email p o ec ed] (O.J.-R.)
*Co espondence: [email p o ec ed]
†Bo h au ho s ha e con ibu ed equally o his wo k.
Recei ed: 5 No embe 2020; Accep ed: 9 Decembe 2020; Published: 11 Decembe 2020
Abs ac :
Cogni i e ail y (CF) is a opic o g owing in e es wi h implica ions o he s udy o
p e en i e in e en ions in aging. Ne e heless, li le esea ch has been done o assess he in luence
o psychosocial a iables on he isk o CF. Ou objec i es we e o es ima e he p e alence o
CF in a Spanish sample and o explo e he in luence o psychosocial a iables in his p e alence.
Physical ail y and cogni i e, unc ional, psychosocial, and socio-demog aphic aspec s we e assessed
in a sample o 285 pa icipan s o e 60 yea s. Uni a ia e and mul i a ia e logis ic eg ession models
we e ca ied ou . A p e alence o 21.8% (95% CI 17.4–26.9) was es ablished when bo h ail and p e- ail
condi ions we e included, and a p e alence o 3.2% (95% CI 1.7–5.9) i only ail indi iduals we e
conside ed. Age, educa ional le el, p o ession and psychological well-being a iables signi ican ly
p edic ed CF. F ail y and p e- ail y a e high-p e alence heal h condi ions in olde adul s in luenced
by socio-demog aphic, socio-educa i e and a ec i e ac o s.
Keywo ds: CogniF aSp; cogni i e ail y; olde adul s; psychosocial ac o s; p e alence
1. In oduc ion
Resea ch pe spec i es on ail y a e making ele an con ibu ions o unde s and he majo
domains ha media e he complex ela ionships be ween aging, on he one hand, and physical and
psychological condi ions, on he o he one. F ail y is con en ionally de ined as a mul idimensional
clinical synd ome, cha ac e ized by loss o biophysical ese e and diminished esis ance o s esso s,
causing ulne abili y o ad e se heal h ou comes and leading o loss o unc ion ha can be exp essed
in di e en ways (i.e., ene gy, physical abili y, cogni ion, and heal h) [
1
,
2
]. F ail y i sel can be classi ied
as physical ail y, cogni i e ail y, o psychosocial ail y [
3
]. The e o e cogni i e ail y (CF) has been
conside ed as a sub ype o ail y [
4
] and i would consis o a he e ogeneous clinical condi ion
cha ac e ized by he simul aneous p esence o bo h physical ail y and mild cogni i e impai men
(MCI) (CDR =0.5), once he diagnosis o demen ia due o Alzheime ’s disease (AD) o o he demen ias
and he condi ion o physical disabili y ha e been excluded [5].
The p e alence o CF was ecen ly es ima ed o be 1% o 5% in communi y-dwelling olde
adul s [
6
–
9
]. Howe e , a ele an he e ogenei y ( anging om 0.9% o 40.0%) is e iden in he
li e a u e and se e al ac o s ha e p obably con ibu ed o such wide a iabili y; hus, he e ha e
been di e ences in he way he wo componen s o cogni i e ail y ha e been ope a ionalized [
10
],
and some o hem ha e also included physical p e- ail y [
11
,
12
]. Likewise, p e alence da a should be
B ain Sci. 2020,10, 968; doi:10.3390/b ainsci10120968 www.mdpi.com/jou nal/b ainsci
B ain Sci. 2020,10, 968 2 o 9
a ec ed by he se ings di e ences. Some s udies we e ca ied ou in clinical se ings [
11
] while o he s
we e communi y-based s udies [
13
,
14
]. In he las ones, including indi iduals wi h physical ail y and
p e- ail y, he p e alence o CF anged om 1 o 40% [
14
], whe eas in clinical-based s udies i anged
om 10.7 o 22.0% [
13
]. Almos all s udies ound ha age was signi ican ly associa ed wi h CF [
15
,
16
]
and p e alence inc eased wi h age [
8
], bu ega ding o he sex and CF associa ion he esul s a e no
ye conclusi e [8,13].
CF can be in luenced by se e al physical isk ac o s and by psychosocial ac o s [
6
], in ensi ying
he ulne abili y o s esso s [
7
]. A key conside a ion when add essing CF is how in insic ac o s as
age, sex, o medical and unc ional capabili ies in e ac wi h ex insic ac o s such as social suppo ,
educa ion le el, o occupa ional ca ego y. In o de o ge a holis ic unde s anding o he ela ionship
be ween aging and ail y, he complexi y o social and psychological ac o s mus be conside ed.
Thus, conside ing ha CF is cha ac e ized by educed cogni i e ese e [
5
], olde people wi h lowe
educa ional le el a ainmen and who ca ied ou non-in ellec ual jobs [
7
,
17
] would end o show
inc eased CF isks.
The e is also e idence o ela ionships be ween he ole o he amily and b oade social ne wo ks
and ail y in la e li e. In his con ex , social engagemen eme ges as a ac o wi h a p o ec i e
o balancing unc ion in he CF le els [
17
]. Howe e , hese social ne wo ks can diminish in la e
li e. In ac , inc easing aging has been ela ed wi h a dec ease in se e al ways o social suppo [
9
]
(
e.g., loss o
pa ne o o he amily membe s o iends), isola ion [
18
], o li ing alone [
19
] ha may
lead o a decline in physical and men al unc ions.
Addi ionally, esea ch on CF equi es a mo e comp ehensi e assessmen o psychological
well-being in o de o cap u e psychological aspec s o cogni i e ulne abili y. Acco ding o his,
some s udies ha e poin ed ou he signi ican associa ion be ween CF and men al heal h s a us,
and speci ically wi h dep essi e mood, anxie y, impa ience, beha io al supp ession and educed desi e
o pa icipa e in social ac i i ies [
20
]. Al hough he in luence o psychosocial a iables on CF has
appea ed in c oss-sec ional [
19
,
21
] and coho s udies on ail y, as a as we know, no s udy has been
designed o speci ically s udy his ela ionship.
The cons uc o CF has igge ed g owing in e es in he scien i ic communi y, bu only a limi ed
amoun o e idence on i s p e alence and he ela ionships be ween psychosocial condi ions and
CF is a ailable. Fu he mo e, no p e ious s udy has analyzed he p e alence o CF in he Spanish
con ex . The aims o his s udy we e o es ablish he p e alence a e o CF on a sample o Spanish
communi y-dwelling olde adul s and o gain knowledge abou he ole o psychosocial a iables
on CF.
2. Ma e ials and Me hods
2.1. Sample
The sample comp ised 285 communi y-dwelling pa icipan s ( om Galicia, NW o Spain and om
Valencia, SE o Spain) aged 60 yea s o mo e, wi hou diagnosis o demen ia, o majo men al heal h
diso de s. O he exclusion c i e ia we e o ha e auma ic inju ies, non-compensable senso y o mo o
de iciencies ha p e en e alua ion, se ious gai dis u bances (inabili y o walk mo e han 10 m wi hou
help, ob ious isk o alling); o use echnical assis ance (cane, c u ches, walke , wheelchai ); and o
su e disabili y and/o ecognized dependency o ins umen al ac i i ies o daily li e. Sampling was
inciden al and was ec ui ed du ing 2018 and 2019. Communi y-dwelling pa icipan s we e ec ui ed
om a la ge on-going s udy on cogni i e aging being unde aken a he Uni e si y o San iago de
Compos ela and Uni e si y o Valencia. Candida es we e ela i es o neighbo s o uni e si y s uden s
and we e in i ed o pa icipa e in he s udy when ac i e li e and he au onomy o he ins umen al
ac i i ies o daily li e we e main ained. The pa icipan s we e e alua ed in hei own homes and
ecei ed no incen i es o hei collabo a ion in he s udy.
B ain Sci. 2020,10, 968 3 o 9
2.2. Measu es
A cus omized p o ocol was de eloped o measu e aspec s ela ed wi h cogni i e pe o mance,
psycho-social ela ed ac o s and physical ail y. The Mon eal Cogni i e Assessmen (MoCA) es was
adminis e ed o de e mine possible MCI pa icipan s [
10
]. To measu e psychological well-being,
he Spanish e sion o he Gene al Heal h Ques ionnai e (GHQ-12) was used [
22
]; he GHQ-12 [
23
]
is a sho en e sion o he GHQ, a sel - epo ques ionnai e used o assess psychological well-being
le el including pe cei ed s ess, anxie y le el, eelings o ea , sleep dis u bances, o psychosoma ic
condi ions. Social suppo was assessed wi h he Spanish e sion o he MOS ques ionnai e (Medical
Ou comes S udy Social Suppo Su ey, MOS-SS) ha is a i e-poin Like scale and pe mi s de ec ion
o si ua ions cha ac e ized by ele a ed social isk [
24
]. Acco ding o he au ho s, a cu -o sco e o
57 poin s was used o lack o social suppo . Age and yea s o educa ion we e also eco ded.
Because his s udy is pa o a la ge esea ch, physical ail y was assessed ollowing a modi ied
e sion o he ail y pheno ype as desc ibed by F ied e al. [
1
]; pa icula ly physical endu ance
was measu ed wi h GHQ i ems and (no wi h GDS-Ge ia ic Dep ession Scale ones) and physical
ac i i y was measu ed wi h a speci ic ques ionnai e (Spanish Sho Ve sion o Minneso a Leisu e Time
Ac i i ies Ques ionnai e) and no only wi h a sel -in o med i em. The ollowing c i e ia we e used:
(1) Weigh loss, measu ed wi h yes/no esponses abou unin en ional weigh loss and lack o appe i e
in he las h ee mon hs; (2) Sel - epo ed exhaus ion, measu ed wi h a ques ion abou dep essed
a ec i e s a e om he GHQ-12 [
22
]; (3) Weakness, measu ed by he g ip s eng h o he dominan
hand, 3 measu emen s a e aken and he a e age is ob ained; (4) Slow gai speed, measu ed h ough a
imed-up and go (TUG) ask in which he pa icipan ha e o ge up om a chai , walk h ee me e s,
u n on himsel , s ep back, and si back down [
25
]; and (5) Low physical ac i i y, measu ed wi h he
sho Spanish e sion o he Minneso a leisu e ime Physical Ac i i y Ques ionnai e (VREM) [26].
Rega ding cogni i e s a us, a e e ence alue o possible cogni i e impai men was es ablished
o MoCA sco es below he 5 h pe cen ile (
−
1.64 s anda d de ia ions), adjus ed o age and educa ional
le el acco ding o he no ma i e sco es by Pe ei o e al. [
27
]. Rega ding ail y s a us, he in olun a y
weigh loss c i e ion is conside ed o be me when he esponse o he ques ion, “Ha e you ea en less
due o poo appe i e, diges i e p oblems, chewing o swallowing di icul ies in he las 3 mon hs?”
o o he ques ion abou ecen weigh loss is posi i e; he c i e ion o low mood is conside ed o be
me when a nega i e answe is eco de o ques ion 9 o he GHQ12, “Ha e you el unhappy and
dep essed?”; he c i e ion o g ip s eng h is conside ed o be me i he pe o mance is below ha
expec ed acco ding o he FNIH c i e ia (men <26, women <16) [
28
]; he c i e ion o low physical
ac i i y is conside ed o be me i he pa icipan is classi ied h ough he VRM as Seden a y [
27
]; inally,
he c i e ion o slow mobili y is conside ed o be me when he pe o mance in he TUG is below he
expec ed alue acco ding o age and sex in a no ma i e sample o mo e han 50 yea s, aking as a
cu -o poin he pe cen ile 84 (1 s anda d de ia ion) adjus ed o age and sex [
29
]. TUG pe o mance
is conside ed abo e he ange, in men: 50 o 54 =7; 55 o 59 =8; 60 o 69 =9; 70 o 79 =10; 80
±
11.
Acco ding o he numbe o c i e ia ha he pa icipan mee s, i will be conside ed: physically obus ,
i hey do no mee any c i e ia; physically p e- ail, i you mee 1 o 2 c i e ia; physically ail, i you
mee 3, 4, o 5 c i e ia.
2.3. S udy Design and P ocedu e
A mo e ex ensi e c oss-sec ional s udy (CogniF aSp, Cogni i e F ail y Spain) was conduc ed
du ing he yea s 2018 and 2019, assessing cogni i e, unc ional, and psychosocial aspec s using alid
assessmen ools and adap ed sel - epo ed es s. The s udy ecei ed app o al by he E hics in Clinical
Resea ch Commi ee o he Galician Go e nmen (2018/620) and he E hics Commi ee o Uni e si y
o Valencia (H1521026499251), and was conduc ed in acco dance wi h he Decla a ion o Helsinki.
W i en in o med consen was ob ained om all pa icipan s.
Following he i e F ied c i e ia, pa icipan s we e classi ied as non- ail, p e- ail, and ail when
hey me no c i e ia, one o wo c i e ia and h ee, ou o i e c i e ia espec i ely. Acco ding o
B ain Sci. 2020,10, 968 4 o 9
hei non- ail, p e- ail o ail pheno ype and hei cogni i e s a us, pa icipan s we e classi ied
as (a) Non- ail-cogni i ely unimpai ed, (b) P e- ail-cogni i ely unimpai ed, (c) F ail-cogni i ely
unimpai ed, (d) Non- ail-possible cogni i e impai men , (e) P e- ail-possible cogni i e impai men ,
and ( ) F ail-possible cogni i e impai men . Acco ding o he gene al c i e ia es ablished by Kelaidi i
e al. [
5
], we conside ed as cases o cogni i e ail y hose wi h a ail and p e- ail pheno ype and
possible cogni i e impai men .
2.4. S udy Ou comes
Age was ca ego ized acco ding o i e age g oups (60–64, 65–69, 70–74, 75–79, 80+yea s
old) and gende was dicho omized in men and women. Rega ding o mal educa ion, conside ing
he cu en le els o o mal educa ion in old adul s in Spain [
30
], educa ion was dicho omized
in low
(7 o less
yea s o educa ion) and high (mo e han 7 yea s o educa ion). P o ession was
dicho omized in low quali ica ion (including unskilled wo ke , housewi e, and no employmen )
and high quali ica ion (including skilled wo ke , ade , senio and middle-le el ci il se an ,
adminis a i e, and managemen s a ).
In ela ion o Cha lson Como bidi y Index, i s sco es we e used o ca ego ize he sample in h ee
g oups (No ch onic condi ions o 0 sco es, One ch onic condi ion o sco e o 1, Two o mo e ch onic
condi ions o sco es highe han 1).
In e ms o ins umen measu emen s, social suppo s a us was dicho omized acco ding o
MOS-SS sco es (Wi h social suppo o sco es o 57 o mo e, Wi hou social suppo o sco es o
56 o less
), while psychological well-being s a us was dicho omized acco ding o GHQ-12 sco es,
using he ecommended cu -o h eshold o men al heal h issues (2/3 poin s), wi h esponses abou
he p esence o di e en a ec i e symp oms sco ed as 0, 0, 1, and 1 espec i ely [23].
2.5. S a is ical Analysis
S a is ical analyses we e ca ied ou wi h SPSS o Windows, e sion 26.0 (IBM co p.,
A monk, NY, USA
). The signi icance le el was es ablished a 0.05 o all analyses. The
χ2
es
was used o ca ego ical a iables. P e alence was es ima ed om he numbe and pe cen age
o cases and odds a ios (OR), wi h 95% con idence in e als. Logis ic eg ession analyses we e
pe o med o p edic he p esence o CF. Pa icipan s wi h CF (p e- ail and ail pheno ype wi h
cogni i e impai men ) we e conside ed cases and hose pa icipan s wi hou cogni i e impai men
(non- ail-cogni i ely unimpai ed, p e- ail-cogni i ely unimpai ed, and ail-cogni i ely unimpai ed)
no cases. Age, gende , yea s o o mal educa ion, p o ession, social suppo s a us, and psychological
well-being le el we e en e ed as independen a iables in uni a ia e analyses. Then, mul i a ia e
logis ic eg ession models we e pe o med including only hose independen a iables conside ed
p edic o s because o a signi ican ela ion (p<0.05) in he p e ious uni a ia e analyses and adjus ing
o possible con ounding.
3. Resul s
Sociodemog aphic cha ac e is ics (age, gende , yea s o educa ion, and p o ession) and le els
o como bidi y acco ding o he Cha lson Como bidi y Index, physical s a us, social suppo ,
and psychological well-being a e shown in Table 1. The p e alence o CF was 21.8% (95%
CI 17.4–26.9
),
wi h 62 cases om a o al sample o 285 pa icipan s. O hose, 9 cases (p e alence 3.2%,
95% CI 1.7–5.9
)
p esen ed cogni i e impai men and physical ail y and 53 cases (p e alence 18.6%,
95% CI 14.5–23.5
)
p esen ed cogni i e impai men and p e-physical ail y. The esul s conce ning he oles o he
independen a iables in he p e alence o CF a e shown in Table 2. Signi ican di e ences we e ound
o age (
χ2
=19.83; p=0.001), wi h he 80+yea g oups showing a signi ican ly highe CF p e alence;
o le el o o mal educa ion (
χ2
=24.22; p<0.001), wi h low educa ion p esen ing highe CF p e alence
han high educa ion; o p o ession (
χ2
=14.71; p<0.001) wi h low quali ica ion p o essions p esen ing
a highe CF p e alence han high quali ica ion p o essions; o psychological well-being (
χ2=7.83
;
B ain Sci. 2020,10, 968 5 o 9
p=0.005
), wi h highe p e alence in hose subg oup p esen ing low psychological well-being acco ding
o GHQ-12 sco es. Gende and como bidi y di e ences we e no signi ican .
Table 1.
Demog aphic p o ile, cogni i e and physical s a us, social suppo , and psychological well-being.
Demog aphic Cha ac e is ics F equencies (%)
Age g oups
60–64 yea s 56 (19.6%)
65–69 yea s 58 (20.4%)
70–74 yea s 57 (20.0%)
75–79 yea s 53 (18.6%)
80 +yea s 61 (21.4%)
Gende
Men 132 (46.3%)
Women 153 (53.7%)
Fo mal educa ion
Low educ. le el 137 (51.7%)
High educ. le el 128 (48.3%)
P o ession
Low quali ica ion 161 (56.5%)
High quali ica ion 124 (43.5%)
Como bidi y
No ch onic condi ions 180 (63.2%)
One ch onic condi ion 74 (26.0%)
Two o mo e ch onic condi ions 31 (10.9%)
Cogni i e and ail y s a us
Non- ail-cogni i ely unimpai ed 80 (28.1%)
P e- ail-cogni i ely unimpai ed 109 (38.2%)
F ail-cogni i ely unimpai ed 14 (4.9%)
Non- ail-cogni i e impai men 20 (7.0%)
P e- ail-cogni i e impai men 53 (18.6%)
F ail-possible cogni i e impai men 9 (3.2%)
Social suppo and psychological well-being
Social suppo s a us
Wi h social suppo 266 (93.3%)
Wi hou social suppo 19 (6.7%)
Psychological well-being
High well-being 237 (83.2%)
Low well-being 48 (16.8%)
Table 2.
P e alence o cogni i e ail y (CF) acco ding o age, gende , o mal educa ion, p o ession,
social suppo s a us, and psychological well-being (uni a ia e logis ic eg ession).
Co a ia es Cases % Wald’s p-Values OR 95% CI
Age g oup
60–64 7/53 13.2 1
65–69 7/54 13 0.01 0.97 0.98 0.32–3.01
70–74 14/52 26.9 2.98 0.084 2.42 0.89–6.61
75–79 9/49 18.4 0.51 0.476 1.48 0.51–4.33
80+25/57 43.9 11.35 0.001 5.13 1.98–13.30
Gende
Men 22/123 17.9 1
Women 40/142 28.2 3.83 0.050 0.55 0.31–1.00
Fo mal educa ion
Low educ. le el 49/137 35.8 21.66 0.001 4.93 2.52–9.64
High educ. le el 13/128 10.2 1
P o ession
Low quali ica ion 47/146 32.2 13.18 <0.001 3.29 1.70–6.26
High quali ica ion 15/119 12.6 1
Como bidi y
No condi ions 38/161 23.6 1
One condi ion 17/74 23.0 0.001 0.975 1.02 0.40–2.55
Two o mo e cond. 7/30 23.3 0.002 0.968 0.98 0.36–2.68
Social suppo
Wi h suppo 58/247 23.5 1
Wi hou suppo 4/18 22.2 0.015 0.903 1.07 0.34–3.39
Psychological
well-being
Low well-being 19/48 39.6 8.19 0.01 2.65 1.36–5.17
High well-being 43/217 19.8 1
B ain Sci. 2020,10, 968 6 o 9
Acco ding o he esul s om uni a ia e models, only he signi ican independen a iables,
age g oup, o mal educa ion, p o ession, and psychological well-being we e included in a mul i a ia e
logis ic eg ession model (see Table 3). The inal model shows a 4.24 inc eased isk in pa icipan s
o 80 and mo e yea s compa ed wi h pa icipan s in he 60–64 age g oup, a 3.43 inc eased isk in
pa icipan s wi h low o mal educa ion compa ed o pa icipan s wi h high educa ion, a 2.56 inc eased
isk in pa icipan s wi h low quali ied p o essions compa ed wi h pa icipan s wi h high quali ied
wo ks, and an inc eased isk o 2.94 in pa icipan s wi h low psychological well-being compa ed wi h
pa icipan s wi h high psychological well-being. The model achie ed a 76.6% o co ec classi ica ions
o he pa icipan s using age, o mal educa ion, p o ession, and psychological well-being as p edic o s,
wi h Hosme –Lemeshow s a is ic indica ing a good i (χ2=8.79; sig. =0.36).
Table 3. Final mul i a ia e logis ic eg ession model.
Co a ia es B S.E. Wald’s p-Values OR 95% CI
Age g oup
60–64 1
65–69 −0.20 0.61 0.11 0.74 0.99 0.31–3.15
70–74 0.56 0.55 1.04 0.31 2.10 0.74–5.96
75–79 −0.16 0.59 0.08 0.78 1.21 0.40–3.67
80+1.00 0.53 6.28 0.05 4.24 1.57–11.44
Fo mal educa ion
Low 1.23 0.38 10.59 0.01 3.43 1.63–7.21
High 1
P o ession
Low quali ica ion 0.94 0.38 6.28 0.001 2.56 0.97–7.70
High quali ica ion 1
Psychol. well-being
No p oblems 1
Men al heal h
p oblems 1.08 0.40 7.43 0.001 2.94 1.35–6.39
4. Discussions
Ou s udy explo ed CF p e alence on a Spanish sample o olde adul s, and p edic i e
associa ions wi h psychosocial a iables such as educa ional le el, de eloped p o ession, social suppo ,
and psychological well-being s a us we e analyzed.
Ou p e alence esul s a e in line wi h mos published s udies in communi y-dwelling
se ings
[14,15]
. Thus, highe CF p e alence is ound when bo h ail and p e- ail condi ions
a e included (21.8%), whe eas much lowe alues a e ound when only ail indi iduals a e
conside ed (3.2%).
Rega ding age, as expec ed [
8
,
15
,
16
], signi ican inc eased isk is ound in he oldes when
compa ed wi h he younges g oup. Rega ding gende , ou s udy showed mo e a o able ends in
men bu , as in p e ious s udies [8,19], no signi ican gende di e ences in CF isk we e ound.
As epo ed in p e ious s udies [
7
,
17
], lowe socio-cul u al s a us, measu ed by low educa ion
le el and low p o essional quali ica ion, is associa ed wi h CF bo h in uni a ia e and mul i a ia e
models. The link is p obably no di ec bu could occu h ough media ing and mode a ing a iables
as li es yle ac o s ela ed o ha s a us (e.g., access o heal h se ices and ac i e aging ac i i ies,
wo k condi ions, and wo k complexi y, encou aging oppo uni ies o he en i onmen , accessibili y
and secu i y o he home en i onmen s, alcohol o o he d ugs use, pa e ns o nu i ion, and le els o
physical exe cise). In ligh o he esul s, social ac o s migh ep esen isk ac o s o he de elopmen
o CF, and he e o e social p o ile should be sys ema ically assessed and aken in o accoun when
e alua ing old adul s o he de elopmen and implemen a ion o mul idimensional p e en ion and
ea men p og ams [
19
]. Fu he mo e, low le el o educa ion and low p o essional a ainmen as wo
co e p oxies o educed cogni i e ese e, appea ed as signi ican p edic o s o CF in bo h uni- and
mul i a ia e analyses [31–33].
B ain Sci. 2020,10, 968 7 o 9
Conce ning psychological well-being le els, a 16.8% o ou sample showed low psychological
wellbeing, and his a iable signi ican ly p edic ed CF in bo h uni a ia e and mul i a ia e models.
Fu he mo e, a 39.6% o people wi h low le el o psychological wellbeing showed CF symp oms.
In line wi h a b oade iew o ail y, men al heal h eme ges as an impo an a iable in CF [
20
,
34
],
and he psychological s a us o indi iduals [
9
] should be included in CF assessmen s. Fu u e s udies
should del e in o he di ec ion o he ela ionship.
In ela ion o heal h s a us, signi ican ela ionships we e no ound wi h physical como bidi y
p obably due o ou objec i e was o in es iga e CF p e alence on communi y-dwelling popula ion,
almos all ee o ch onic heal h condi ions.
Simila ly, ou esul s did no show signi ican associa ion be ween social suppo and CF. Howe e ,
i is in e es ing o no e ha he whole sample showed a e y high a e o pe cei ed social suppo
(93.3%), which is p obably ela ed o cul u al ac o s (high densi y o social con ac s, amily-o ien ed
models o p e e ence wi h high con ac s wi h he closes membe s o he amily o o igin) and may
posi i ely in luence he psychological and cogni i e s a us o Spanish olde people [35,36].
As o he limi a ions o he s udy, al hough he size sample is accep able o he objec i es, i would
be desi able o ex end he s udy wi h la ge samples ec ui ed by ep esen a i e sampling p ocedu es
o gain g ea e awa eness o CF p e alence and psychosocial ac o s ela ed. On he o he hand, as a
as hei ela ion o he p e alence ound, he exclusion c i e ia used a e cohe en wi h he de ec ion o
agili y and cogni i e agili y, as in ended in his s udy bu , consequen ly, would exclude a pa o
elde ly people wi h some mo o and/o men al heal h como bidi ies.
5. Conclusions
A CF p e alence o 21.8% was es ablished in a sample o Spanish communi y-dwelling old adul s
when bo h ail and p e- ail condi ions we e included. A CF p e alence o 3.2% was es ablished when
only ail indi iduals we e conside ed. Age, educa ional le el, p o ession and psychological well-being
signi ican ly p edic ed CF. The ole o lowe socio-cul u al s a us, measu ed by low educa ion le el
and low p o essional quali ica ion, and low psychological well-being le els mus be aken in o accoun
in CF assessmen .
Au ho Con ibu ions:
Concep ualiza ion, E.N.-P., D.F., M.C.-M., A.X.P., and O.J.-R.; me hodology, E.N.-P., D.F.,
M.C.-M., A.X.P., and O.J.-R.; so wa e, D.F. and A.X.P.; alida ion, E.N.-P., D.F., M.C.-M., A.X.P., and O.J.-R.;
o mal analysis, D.F. and A.X.P.; da a cu a ion, M.C.-M.; w i ing—o iginal d a p epa a ion, E.N.-P. and D.F.;
w i ing— e iew and edi ing, M.C.-M., A.X.P., and O.J.-R. All au ho s ha e ead and ag eed o he published
e sion o he manusc ip .
Funding:
This esea ch was unded by h ough FEDER ounds by he Spanish Di ec o a e Gene al o Scien i ic and
Technical Resea ch (P ojec Re . PSI2014–55316-C3–1-R); and by he Galician Go e nmen (
Conselle ía de Cul u a
,
Educaci
ó
n e O denaci
ó
n Uni e si a ia; axudas pa a a consolidaci
ó
n e es u u aci
ó
n de unidades de in es igaci
ó
n
compe i i as do Sis ema Uni e si a io de Galicia; GI-1807-USC: Re . ED431–2017/27).
Con lic s o In e es : The au ho s decla e no con lic o in e es .
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