Meaning in life and cognitive frailty in older adults: Longitudinal associations and psychosocial pathways in the English Longitudinal Study of Ageing

Objectives Cognitive frailty (CF), the co-occurrence of physical frailty and cognitive impairment without dementia, is a potentially reversible, high-risk state linked to dementia and mortality, underscoring the need to identify modifiable determinants. Meaning in life (MiL) has been associated with lower risks of frailty and cognitive impairment, suggesting it may protect against CF. We examined whether higher MiL reduces the odds of CF, whether associations differ by sex or age, and whether psychosocial factors mediate these associations. Methods Data were drawn from participants aged ≥ 50 years in the English Longitudinal Study of Ageing (2002–2024). CF was defined as concurrent frailty (frailty index > 0.25) and cognitive impairment without dementia. MiL was measured using the Control, Autonomy, Self-Realization and Pleasure (CASP-19) scale. Logistic regression models estimated associations between MiL and CF, adjusting for sociodemographic, socioeconomic, and psychosocial covariates. Mediation analyses tested indirect effects via depression, loneliness, social isolation, and cognitive reserve. Results Higher MiL was associated with reduced odds of CF (OR = 0.93, 95% CI 0.87–0.99), with a prospective effect in lagged longitudinal models (OR = 0.91, 95% CI 0.85–0.98). The association was modestly stronger among men ( p  = 0.047) but did not vary by age. Depression (54%), loneliness (33%), and cognitive reserve (13%) mediated substantial proportions of the relationship, while social isolation contributed minimally (5%). Discussion MiL independently predicts lower risk of CF, largely through reduced depression, loneliness and enhanced cognitive reserve. Interventions that foster meaning should be integrated within multidomain healthy ageing strategies.