Assessment of cognition and psychological capacity of older adults: A cross-sectional study

Abstract

Background: The ageing population is increasing globally, with the number of older adults aged 60 years or more expected to reach 2.1 billion by 2050. Bangladesh is no exception, with a current older population of approximately 15.3 million, projected to double by 2050. Cognitive decline and reduced psychological capacity are two important yet under-recognised challenges of ageing. However, no assessment of these domains using the World Health Organization’s Integrated Care for Older People (ICOPE) has been conducted in Bangladesh.

Objectives: To assess the status of cognition and psychological capacity in older adults in rural Bangladesh and identify factors associated with the decline of these domains.

Methods: A cross-sectional study was conducted among 402 older adults aged ≥ 60 years in three wards within the Sujalpur union of Birganj subdistrict, Dinajpur, Bangladesh, from March to April 2026. A simple random sampling technique was used to select the study participants. Bangla adaptation of the Mini-Mental State Examination (BAMSE) and Patient Health Questionnaire-9 (PHQ-9) were used to assess cognitive status and depressive symptoms. A score of less than 24 on the BAMSE was considered to indicate cognitive decline, and a score of more than 10 on the PHQ-9 was considered to indicate depressive symptoms. Data were analysed using Stata V.17.0, and descriptive and multivariable logistic regression analyses were performed.

Results: The prevalence of cognitive decline was 41.8 % (n=168), and the prevalence of depressive symptoms was 46.8% (n=188). Female sex (adjusted odds ratio (aOR): 2.84, 95% CI: 1.57-5.12) and adequate physical activity (aOR: 0.59, 95% CI: 0.37-0.95) were associated with cognitive decline. Socio-economic factors related to depressive symptoms were the highest household wealth tertile (aOR: 0.57, 95% CI: 0.32-0.99) and female sex (aOR: 2.14, 95% CI: 1.17-3.93), malnutrition (aOR: 3.42, 95% CI: 1.65-7.12), and adequate sleep ≥7 hours (aOR: 0.40, 95% CI: 0.24-0.66) were associated with depressive symptoms.

Conclusions: A high prevalence of cognitive decline and depressive symptoms was observed among older adults in rural Bangladesh. Factors such as sex, household wealth, physical activity, sleep, and nutritional status emerged as key determinants and should be considered when developing targeted interventions for older adults. These findings underscore an urgent need to integrate cognitive and psychological care into primary healthcare using the ICOPE framework.