Physical Versus Cognitive Impairment in Stroke-Free Older Adults Living in Rural Settings: Relative Contributions to Decreased Functionality

Objectives: Both physical and cognitive impairments contribute to disability. However, their relative impact on functional decline among older adults in low-resource settings has not been adequately studied. This study aims to explore the role of these factors on functionality. Methods: Following a population-based, cross-sectional design, older adults living in rural Ecuador underwent a handgrip strength (HGS) test for physical performance, the Montreal Cognitive Assessment (MoCA) to evaluate cognitive performance, and a Functional Assessment Questionnaire (FAQ) assessed functionality. A generalized structural equation modeling (GSEM) approach was utilized to evaluate a predefined set of causal assumptions and integrate hypothesized latent constructs, providing a comprehensive explanation of the relationships among multiple interconnected variables and their association with dysfunctionality. Results: We included 603 individuals (mean age: 67.5 ± 7 years; 54% women). According to the GSEM approach, a 10% rise in HGS (2.4 kg) was associated with a 3.68% improvement in functionality (p < 0.001), whereas a 10% increase in MoCA scores resulted in a 2.06% improvement in functionality (p < 0.001). One standard deviation (SD) in HGS comprised 18% of the distribution, which yielded a 6.5% shift in functionality. Similarly, one SD difference in MoCA scores accounted for 19% of the distribution, and a 3.91% change in functionality. Conclusions: Both physical and cognitive impairments significantly contribute to decreased functionality. However, physical performance exerts a greater influence on functional independence than cognitive performance. These findings highlight the importance of a holistic approach to interventions aimed at enhancing quality of life in older adults residing in low-resource rural settings.