Limited formal education is strongly associated with lower cognitive status, functional disability and frailty status in the older adults

Limited formal education is still common in ageing populations. Even though limited formal education seems to be independently and negatively associated with cognition, functional abilities and frailty in ageing, no study has examined if a gradient of limited formal education would have a steady impact on later life health. Objective: To examine the relationship of limited formal education with cognitive status, functional abilities, and frailty status. Methods: Cross-sectional study with 540 older adults divided in groups: no formal education, 12-24 months of education, and 25-48 months of education. Cognitive screening (MMSE), functional abilities (Lawton Index); frailty (CHS criteria) were measured. Regression analyses were performed. Results: 27% had no formal education, 21% had between 12-24 months of formal education, and 55% had between 25-48 months of formal education. Limited formal education has a clear gradient of negative impact: No formal education was linked to scoring below MMSE cut-off scores (OR=7.9), being totally/partially dependent in IADLs (OR=2.5) and frail (OR=2.0). Having 12-24 months of education was associated with scoring below MMSE cut-off scores (OR=5.2) and to being frail (OR=2.0). The No formal education group was 10.1 times more probable of presenting with worse cognitive scores, worse functional abilities and frailty/pre-frailty concomitantly (CCoFF), while older adults who had between 12-24 months of education had 4.6 times greater chance to present with CCoFF. Conclusions: The limited education presented a gradient association to cognitive performance, functional disability and frailty. These findings clearly emphasize the importance of prevention through education from childhood to older age.