Abstract
BackgroundFew empirical studies support a bio-psycho-social conceptualization of frailty. In addition to physical frailty (PF), we explored mental (MF) and social (SF) frailty and studied the associations between multidimensional frailty and various adverse health outcomes.MethodsCross-sectional and longitudinal analyses were conducted using data from a population-based cohort (SLAS-1) of 2387 community-dwelling Singaporean Chinese older adults. Outcomes examined were functional and severe disability, nursing home referral and mortality. PF was defined by shrinking, weakness, slowness, exhaustion and physical inactivity, 1–2 = pre-frail, 3–5 = frail; MF was defined by ≥1 of cognitive impairment, low mood and poor self-reported health; SF was defined by ≥2 of living alone, no education, no confidant, infrequent social contact or help, infrequent social activities, financial difficulty and living in low-end public housing.ResultsThe prevalence of any frailty dimension was 63.0%, dominated by PF (26.2%) and multidimensional frailty (24.2%); 7.0% had all three frailty dimensions. With a few exceptions, frailty dimensions share similar associations with many socio-demographic, lifestyle, health and behavioral factors. Each frailty dimension varied in showing independent associations with functional (Odds Ratios [ORs] = 1.3–1.8) and severe disability prevalence at baseline (ORs = 2.2–7.3), incident functional disability (ORs = 1.1–1.5), nursing home referral (ORs = 1.5–3.4) and mortality (Hazard Ratios = 1.3–1.5) after adjusting for age, gender, medical comorbidity and the two other frailty dimensions. The addition of MF and SF to PF incrementally increased risk estimates by more than 2 folds.ConclusionsThis study highlights the relevance and utility of PF, MF and SF individually and together. Multidimensional frailty can better inform policies and promote the use of targeted multi-domain interventions tailored to older adults’ frailty statuses.
Highlights
Few empirical studies support a bio-psycho-social conceptualization of frailty
Older adults with physical and mental frailty can benefit from appropriate exercise and cognitive stimulation programs and activities while those with mental and social frailty can benefit from additional cognitive stimulation and appropriate psychosocial support
We examined the hypothesis that the addition of mental frailty (MF) and social frailty (SF) to physical frailty (PF) increases the ability to predict the aforementioned health outcomes
Summary
Few empirical studies support a bio-psycho-social conceptualization of frailty. In addition to physical frailty (PF), we explored mental (MF) and social (SF) frailty and studied the associations between multidimensional frailty and various adverse health outcomes. There exist few empirical studies investigating the relationships between each frailty dimension, especially with regards to their independent and relative contributions in predicting functional disability, hospitalization and other adverse health outcomes. There is little evidence on whether the addition of qualitatively different frailty dimensions to physical frailty can better predict adverse health outcomes. Older adults with physical and mental frailty can benefit from appropriate exercise and cognitive stimulation programs and activities while those with mental and social frailty can benefit from additional cognitive stimulation and appropriate psychosocial support
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