Comprehensive Frailty Assessment Instrument Research Articles

The mediating role of self-directed ageism on frailty and quality of life in community-dwelling older people

PurposeThe purpose of this study was to explore the role of self-directed ageism in the relationship between frailty and quality of life in community-dwelling older adults.MethodsSecondary data-analysis on data from the Belgian Ageing Studies. A stratified sample of 1895 participants, based on census data by gender and age, was drawn between 2017 and 2019. Frailty, quality of life and self-directed ageism were assessed by the Comprehensive Frailty Assessment Instrument, a numeric rating scale and a newly developed self-directed ageism scale, respectively. The validity of this new scale was assessed by exploratory factor analysis, while mediation analysis was used to explore if self-directed ageism mediates the relationship between frailty and quality of life.ResultsThe self-directed ageism scale proved highly reliable (Cronbach’s α = 0.898, Spearman-Brown = 0.906), explaining 58.86% of the variance in self-directed ageism. Respondents scored an average of 23.6 on 40 for self-directed ageism, 26.94 on 100 for frailty, and a median of 8 on 10 for quality of life. Mediation analysis showed that frailty negatively correlates with quality of life, and that this relationship is partially mediated by self-directed ageism.ConclusionMost respondents were identified as mild frail, experienced self-directed ageism, and those 80 or older rated their quality of life lower. The present study showed that frailty negatively correlates with quality of life and this relationship is partially mediated by self-directed ageism. We conclude that every effort should be made to prevent frailty, ageism and self-directed ageism as they impact community-dwelling older people’s quality of life.

The association between internet non-use and multidimensional frailty in older adults: a three-wave cross-sectional study from 2004 to 2021

ABSTRACT This study examined the association between frailty and internet (non-)use, using representative data – collected between 2004 and 2021 – of community dwelling people aged 60 and older living in Flanders, Belgium (N = 43,048). Multidimensional frailty was measured by the Comprehensive Frailty Assessment Instrument (CFAI), which is a reliable and valid instrument to assess physical, psychological, social and environmental dimensions of frailty. Internet use was dichotomised into users and non-users. Multivariable regression analyses revealed that the physical domain is the most strongly related frailty factor to internet (non-)use, and this has been a constant trend since 2004. Those in the high physical frailty group have the highest probabilities of being non-user and are up to 8.0% more likely to be non-user than those in the ‘no-low’ physical frailty group. Future research should investigate how human-technology interaction can be improved and make internet technologies more manageable for physical frail older adults. However, average marginal effects indicate that sociodemographic variables are more strongly related to internet (non-)use than frailty domains. This result shows that internet non-use in older people is multifactorial in origin and not only attributed to their frailty status.

Frailty as a determinant of dental attendance among community-dwelling older adults.

The aim of this study was to assess the association between different levels of frailty and dental attendance among home-dwelling older adults, in Belgium. While many determinants of dental attendance among older adults have been identified, no study has focused on the role of frailty. This was a cross-sectional study on a random sample of home-dwelling adults aged 60 and over from two Belgian cities. Data were collected with a structured questionnaire through a participatory peer-research method. Time since the last dental attendance was the dependent variable. The independent variable was frailty, assessed with the Comprehensive Frailty Assessment Instrument, including physical, psychological, social, and environmental subdomains. Covariates were age, gender, having a partner, educational level, and household income, as well as self-perceived oral health. Data analysis included descriptive, bivariate (Chi-Square, ANOVA, and Kruskal-Wallis), and binomial logistic regression analyses. The sample consisted of 1329 older adults with a mean age of 72.5 years (SD 8.9, range 60-103). In the low frailty group, 73% attended the dentist in the previous 12 months, while it was 62% and 54% in the medium and high frailty groups, respectively. In the fully adjusted model, the initial gradient in the relationship between overall frailty and dental attendance remained; those in the medium and the high frailty groups were respectively 1.46 (95% CI: 1.09, 1.95) and 1.67 (95% CI: 1.15, 2.43) times more likely to report no dental attendance in the previous year than the low frailty group. Similar associations could be seen in the physical and environmental frailty subdomains. Frailty is consistently associated with less favourable dental attendance, independent from age, gender, socioeconomic factors, family composition, and self-perceived oral health. Once frailty has been detected, good interprofessional communication and care are needed to avoid the drop-out of older adults from the oral healthcare system.

Prevalence and associated factors of frailty among community dwelling older adults in Northwest China: a cross-sectional study

ObjectivesTo investigate the prevalence of the comprehensive frailty and its associated factors among community dwelling older adults.DesignA cross-sectional study.SettingSix community healthcare centres in Xi’an City, Northwest China.ParticipantsA total of 2647...

Validation of the Persian version of the comprehensive frailty assessment instrument plus in community-dwelling older adults

This study aimed to examine the validity and reliability of the Persian Version of the Comprehensive Frailty Assessment Instrument Plus (CFAI-Plus) among community-dwelling older adults. It was completed by 340 older adults ≥60 years. The content and face validity were confirmed based on the opinion of the target group and experts. In the exploratory factor analysis, seven factors were extracted, explaining 62.8% of the total variance. Confirmatory factor analysis showed acceptable fit indices (Root Mean Square Error of Approximation = 0.045; Comparative Fit Index = 0.93; Tucker-Lewis Index = 0.92). Internal consistency was adequate for factors (Cronbach's alpha: range 0.47 to 0.88), and the test-retest reliability was acceptable (intra-class correlation coefficient: range 0.76 to 0.92). A higher CFAI-Plus score were found in those who were older, female, less-educated, single, lived alone, and had inadequate income. This study supports the reliability and validity of the Persian CFAI-Plus in community-dwelling older adults.

The relation between age of retirement and frailty in later life? A cross-sectional study in Flemish older adults

BackgroundPolicymakers in several European countries, concerned about the sustainability of their pension system, have raised the statutory retirement age. While several studies investigated the effect of retirement on health, the relationship between retirement and frailty is neglected. Notwithstanding, frailty is associated with adverse outcomes. ObjectiveThe aim of this study was to examine the relationship between age of retirement and frailty in later life. MethodsData of the Belgian Ageing Studies, a cross-sectional research project was used. The present study includes N=12659 participants (>60y) in 83 Flemish municipalities. To address reverse causality, only participants not retired because of health-related reasons were included. The Comprehensive Frailty Assessment Instrument, a multidimensional frailty scale with four domains (physical, psychological, social and environmental) was used to operationalize frailty. Univariate general linear regression analyses (GLM) were performed for scores on the total frailty scale and the four subdomains separately. The analysis was done for men and women separately, since both groups have different labor trajectories. ResultsThe present study found a negative association between age of retirement and physical frailty for both men and women in later life, and total frailty for men, although the differences were small. No evidence was found for a relation between age of retirement and the other subdomains of frailty. ConclusionsThe results suggest that age of retirement is not a clinically relevant predictor for frailty in later life. Differences within and between subpopulations (e.g., profession) can shed a new light on this relation.

Towards a more effective strategy to detect community-dwelling frail older adults: validation of risk factors

PurposeIn the context of early detection of frail older people, prior research found several risk factors of multidimensional frailty. The current study aims to validate these risk factors.Design/methodology/approachTwo data sets, Belgian Ageing Studies and Detection, Support and Care for older people: Prevention and Empowerment (BAS and D-SCOPE), in three Belgian municipalities (Ghent, Knokke-Heist and Thienen) were used and compared. The BAS data set (N = 1496) is a representative sample of community-dwelling older adults (60+), while the recruitment of the D-SCOPE sample (validation sample, N = 869) is based on risk factors (e.g. age, marital status, moved in the past 10 years). Frailty was measured with the comprehensive frailty assessment instrument (CFAI). The validity was examined by means of prevalence rates, distribution and the odds rates within both data sets.FindingsThe validation sample had an increase in the percentage of elderly who were mildly and highly frail for physical frailty (men: +17.0 percent point, women: +20.7 percent point), for psychological frailty (men: +13.4 percent point, women: +13.7 percent point), for social frailty (men: +24.8 percent point, women: +4.8 percent point) and environmental frailty (men: +24.2 percent point, women: +6.8 percent point). The present results indicate that the risk of being mildly or highly frail was higher in the validation sample in comparison with the BAS data.Originality/valueThe present study proved the validity of aforementioned risk factors. Selecting older people based on these risk factors proved to be an effective strategy for detecting frail older people.

Predictive performance of 7 frailty instruments for short-term disability, falls and hospitalization among Chinese community-dwelling older adults: A prospective cohort study

BackgroundFrailty becomes a great challenge with population aging. The proactive identification of frailty is considered as a rational solution in the community. Previous studies found that frailty instruments had insufficient predictive accuracy for adverse outcomes, but they mainly focused on long-term outcomes and constructed frailty instruments based on available data not original forms. The predictive performance of original frailty instruments for short-term outcomes in community-dwelling older adults remains unknown. ObjectiveTo examine the predictive performance of seven frailty instruments in their original forms for 1-year incident outcomes among community-dwelling older adults. DesignA prospective cohort study. SettingsA total of 22 communities were selected by a stratified sampling method from one Chinese city. ParticipantsA total of 749 older adults aged ≥ 60 years (mean age of 69.2 years, 69.8% female) were followed up after 1 year. MethodsBaseline frailty was assessed by three purely physical dimensional instruments (i.e. Frailty Phenotype, the Study of Osteoporotic Fracture and FRAIL Scale) and four multidimensional instruments (i.e. Frailty Index, Groningen Frailty Indicator, Tilburg Frailty Indicator and Comprehensive Frailty Assessment Instrument), respectively. Outcomes included incident disability, falls, hospitalization and the combined outcome at 1-year follow-up. The receiver operating characteristic curves were plotted to assess the predictive performance of frailty instruments. ResultsThe areas under the curves of seven frailty instruments in predicting incident outcomes ranged from 0.55 [95% confidence interval (CI): 0.51–0.60] to 0.67 (95% CI: 0.61–0.72), with high specificity (72.3–99.2%) and low sensitivity (4.0–49.6%). Four multidimensional instruments had much higher sensitivity (20.9–49.6% versus 4.0–11.7%) than three purely physical dimensional instruments. Overall, the Frailty Index was more accurate than some instruments in predicting incident outcomes, while several self-report instruments had comparable predictive accuracy to the Frailty Index for all (FRAIL Scale) or some (Groningen Frailty Indicator and Tilburg Frailty Indicator) of the incident outcomes. ConclusionsAll frailty instruments have inadequate predictive accuracy for short-term outcomes among community-dwelling older adults. The Frailty Index roughly performs better but self-report instruments are comparable to the Frailty Index for all or some of the outcomes. An accurate frailty instrument needs to be developed, and the simple self-report instruments could be used temporarily as practical and efficient tools in primary care.

Comparison of 6 frailty screening tools in diagnostic properties among Chinese community-dwelling older people

We aimed to compare the diagnostic test accuracy (DTA) of six frailty screening tools against comprehensive geriatric assessment (CGA) in the community. A total of 1177 community-dwelling older people were recruited. Frailty was assessed by purely physical tools including Physical Frailty Phenotype (PFP), FRAIL (fatigue, resistance, ambulation, illness and loss of weight), Study of Osteoporotic Fracture (SOF), and multidimensional tools including Tilburg Frailty Indicator (TFI), Groningen Frailty Indicator (GFI) and Comprehensive Frailty Assessment Instrument (CFAI). The receiver operating characteristic curve analyses were performed. The GFI, TFI and CFAI [areas under the curve (AUCs): 0.78–0.80] had better diagnostic accuracy than SOF, PFP and FRAIL (AUCs: 0.69–0.72) (χ2: 6.37–26.76, P<.05). The optimal cut-offs for the PFP, FRAIL and SOF were identical to their original prefrail cut-offs. These results implicate that the multidimensional tools are more effective to identify frailty in the whole community setting, while the self-report FRAIL may be used to identify the prefrail and facilitate early interventions particularly in the community setting with adequate healthcare resources.

The association between frailty and medication adherence among community-dwelling older adults with chronic diseases: Medication beliefs acting as mediators

ObjectiveTo explore the association between frailty and medication adherence by modeling medication beliefs (i.e., necessity and concerns) as mediators among community-dwelling older patients. MethodsThis cross-sectional study was conducted among 780 Chinese older patients. Frailty, medication adherence and medication beliefs were assessed using the Comprehensive Frailty Assessment Instrument (CFAI), the 4-item Morisky Medication Adherence Scale (MMAS-4) and the Beliefs about Medicines Questionnaire-Specific (BMQ-Specific), respectively. The PROCESS SPSS Macro version 2.16.3, model 4 was used to test the significance of the indirect effects. ResultsFrailty was associated with high medication necessity (β = 0.091, p = 0.011) and high medication concerns (β = 0.297, p < 0.001). Medication adherence was positively associated with medication necessity (β = 0.129, p = 0.001), and negatively associated with medication concerns (β = −0.203, p < 0.001). Medication necessity and medication concerns attenuated the total effect of frailty on medication adherence by −13.6% and 70.3%, respectively ConclusionHigh medication concerns among frail older patients inhibit their medication adherence, which cannot be offset by the positive effect of their high medication necessity on medication adherence. Practice implicationsInterventions should target medication beliefs among frail older patients, particularly medication concerns, to efficiently improve their medication adherence.

The association between perceived social and physical environment and mental health among older adults: mediating effects of loneliness

Objectives: Despite growing interest in the impact of physical and social environment on mental health, data are lacking on the potential mediating effects of loneliness. We examined it in the association of several social and physical environmental characteristics with mental health among older adults in three municipalities in Flanders (Belgium).Methods: A total of 869 people aged 60 and over were interviewed. Loneliness was assessed through the De Jong Gierveld short scales for emotional and social loneliness. Social participation and social cohesion were assessed following the Neighborhood scales whereas physical environment characteristics were selected from the Neighborhood Environment Walkability Scale. Mental health was assessed through subscale psychological frailty of the Comprehensive Frailty Assessment Instrument plus (CFAI-plus). Linear regression models, including mediation analysis, were used to analyze the survey data.Results: After adjusting for individual characteristics, physical and social environment factors were significantly related to mental health with the significant mediation of emotional and social loneliness. Percentages mediated by both dimensions together were 61% for social cohesion, 43% for social participation, 35% for safety and 25% for mobility. Compared with social loneliness, emotional loneliness was a stronger mediating factor, particularly for mobility and safety. No significant associations between traffic density or basic service availability and mental health were found.Discussion: Improving the social and physical environment might result in a reduction in the prevalence of loneliness and in consequent improvement of mental health among older adults. Special attention should be paid to different types of loneliness.

Concordances and differences between a unidimensional and multidimensional assessment of frailty: a cross-sectional study

BackgroundMany instruments to identify frail older people have been developed. One of the consequences is that the prevalence rates of frailty vary widely dependent on the instrument selected. The aims of this study were 1) to examine the concordances and differences between a unidimensional and multidimensional assessment of frailty, 2) to assess to what extent the characteristics of a ‘frail sample’ differ depending on the selected frailty measurement because ‘being frail’ is used in many studies as an inclusion criterion.MethodA cross-sectional study was conducted among 196 community-dwelling older adults (≥60 years), which were selected from the census records. Unidimensional frailty was operationalized according to the Fried Phenotype (FP) and multidimensional frailty was measured with the Comprehensive Frailty Assessment Instrument (CFAI). The concordances and differences were examined by prevalence, correlations, observed agreement and Kappa values. Differences between sample characteristics (e.g., age, physical activity, life satisfaction) were investigated with ANOVA and Kruskall-Wallis test.ResultsThe mean age was 72.74 (SD 8.04) and 48.98% was male. According to the FP 23.59% was not-frail, 56.92% pre-frail and 19.49% frail. According to the CFAI, 44.33% was no-to-low frail, 37.63% was mild frail and 18.04% was high frail. The correlation between FP and the CFAI was r = 0.46 and the observed agreement was 52.85%. The Kappa value was κ = 0.35 (quadratic κ = 0.45). In total, 11.92% of the participants were frail according to both measurements, 7.77% was solely frail according to the FP and 6.21% was solely frail according to the CFAI. The ‘frail sample respondents’ according to the FP had higher levels of life satisfaction and net income, but performed less physical activities in comparison to high frail people according to the CFAI.ConclusionThe present study shows that the FP and CFAI partly measure the same ‘frailty-construct’, although differences were found for instance in the prevalence of frailty and the composition of the ‘frail participants’. Since ‘being frail’ is an inclusion criterion in many studies, researchers must be aware that the choice of the frailty measurement has an impact on both the estimates of frailty prevalence and the characteristics of the selected sample.

Exploring Cognitive Frailty: Prevalence and Associations with Other Frailty Domains in Older People with Different Degrees of Cognitive Impairment

Background: Cognitive frailty has long been defined as the co-occurrence of mild cognitive deficits and physical frailty. However, recently, a new approach to cognitive frailty has been proposed: cognitive frailty as a distinct construct. Nonetheless, the relationship between this relatively new construct of cognitive frailty and other frailty domains is unclear. Objectives: The aims of this study were to explore the prevalence of cognitive frailty in groups with different degrees of cognitive impairment, as well as to explore the associations between frailty domains, and if this varies with level of objective cognitive impairment. Method: Cross-sectional, secondary data from 3 research projects among community-dwelling people aged ≥60 years, with different degrees of objective cognitive impairment, were used: (1) a randomly selected sample (n = 353); (2) a sample at an increased risk of frailty (n = 95); and (3) a sample of memory clinic patients who scored 0.5 on the Clinical Dementia Rating scale – according to the “original” definition of cognitive frailty (n = 47). Multidimensional frailty was assessed with the Comprehensive Frailty Assessment Instrument – Plus and general cognitive functioning with the Montreal Cognitive Assessment. Descriptive statistics and linear regression were used to determine the prevalence of cognitive frailty and to explore the relationship between cognitive frailty and the other types of frailty in each sample. Results: The prevalence of cognitive frailty increased along with the degree of objective cognitive impairment in the 3 samples (range 35.1–80.9%), while its co-occurrence with (one of) the other types of frailty was most frequent in the frail and community samples. Regarding its relationship with the other domains, cognitive frailty was positively associated with psychological frailty’s subdomain mood disorder symptoms in all 3 samples (p ≤ 0.01), while there was no significant association with environmental frailty and social loneliness. The associations between cognitive frailty and the other types of frailty differed between the samples. Conclusion: Psychological and cognitive frailty are strongly associated, irrespective of the objective degree of cognitive impairment. In addition, it is shown that cognitive frailty can occur independently from the other frailty domains, including physical frailty, and therefore it can be seen as a distinct concept.

The association between frailty and quality of life when aging in place

Background and objectivesAdvanced age is often associated with frailty, which in turn is associated with low quality of life. This study explores to what extent multidimensional frailty is associated with multidimensional quality of life. Material and methodsA cross-sectional survey study was conducted in a sample of 336 Flemish older people aging in place. Data were collected between 2014 and 2016 using two multidimensional self-reporting instruments; the Comprehensive Frailty Assessment Instrument to assess frailty and the World Health Organization Quality of Life Instrument-Short Version to assess quality of life. Bivariate analyses were used to explore the relationship between quality of life, associated factors of quality of life and frailty. ResultsThe mean age of the respondents was 74.9 years and 71.7% were woman. An inverse correlation was found between frailty and quality of life (r = −.683) and the corresponding subdomains. Nevertheless, some respondents perceived their quality of life as high, although they were defined as mild to high frail. Further analysis indicated that neither socio-demographic factors nor being ill contributed to quality of life. Discussion and implicationsPsychological frailty contributed the most to quality of life. However, the results indicate that frailty does not inevitably leads to a lower quality of life and that other factors, besides frailty, play an important role in determining quality of life. Knowledge about these factors and their mutual relationship can help policymakers and services in providing client-centered care to increase or maintain the quality of life of people aging in place.

The importance of sources of meaning in life of community dwelling psychologically frail older people

Purpose Psychological frailty adds most to overall feelings of frailty, but is often neglected, although meaning in life is important for psychological well-being. The purpose of this paper is to explore the sources of meaning in life within psychologically frail older people. Design/methodology/approach Data (n= 16,872) generated from the Belgian Ageing Studies were collected, using the Comprehensive Frailty Assessment Instrument and the Sources of Meaning Profile (SOMP-R) instrument. Psychometric properties of the SOMP-R were explored using factor and reliability analysis and one-way-ANOVA analysis were used to asses mean differences. Findings Financial security, meeting basic needs and personal relations play an important role as sources of meaning in life. Moreover, the SOMP-R showed excellent psychometric properties. Research limitations/implications Due to the cross-sectional design of this study, evolution in time and causal links could not be assessed. Practical implications The findings of this study emphasize that sources of meaning in life are relevant and can be assessed using the SOMP-R upon which individually tailored care plans can be developed. The results show that, meaning in life as such plays an important role for psychologically frail older people. As a consequence, this offers insights to support these older people. Caregivers and policymakers might therefore take these results into account. Guarantee and/or follow up a frail individual’s financial security, assessing and enabling one’s personal relationships and meeting their basic needs are very important when taking care of psychologically frail older individuals. Social implications Besides the practical implications, the social inclusion of psychologically frail older people seems to be relevant. Originality/value To the best of the authors’ knowledge, the association between meaning in life and psychological frailty in later life is not yet investigated. Further the findings of this study emphasize that sources of meaning in life are relevant and can be assessed using the SOMP-R upon which individually tailored care plans can be developed.

Psychological Frailty and Quality of Life of Community Dwelling Older People: a Qualitative Study

In general, frailty is associated with deficits and adverse health outcomes and a low quality of life. This study was designed to get more insight into older psychologically frail peoples’ Quality of Life (QoL), lived experiences and personal strategies. Data of 121 community dwelling older people, were collected between November 2015 and March 2016, using a multi-actor and mixed-method approach. Of this sample, seven high psychological frail participants who experienced or expected an improvement of their QoL were selected. Psychological frailty was measured by the Comprehensive Frailty Assessment Instrument and QoL by using numeric rating scale. For the qualitative study, semi-structured interviews were conducted. The interviews were analyzed using an interpretative phenomenological approach. Respondents pointed financial resources, good health, connectedness, and meaningful activities as determinants for their QoL. Strategies to have or maintain a good QoL in later life, when confronted with frailty, were: adequate problem solving, support seeking, cognitive restructuring and religious coping mechanisms. Older people, despite being high psychologically frail, experience or can maintain or improve their QoL. As a consequence, all people involved with psychologically frail older people are encouraged to change their view towards the relationship between frailty and QoL and to focus more on individual’s strengths and abilities.

Detection of high psychological frail community dwelling older people using socioeconomic indicators

Aim: Within an aging in place policy, detection of frail community dwelling older people is a challenge. Moreover, previous research showed that psychological frailty contributes most to the overall feelings of frailty, pointing towards the necessity of detection. The main purpose of this study is to explore the socioeconomic profile of frail community dwelling older people in order to determine the possible risk factors of psychological frailty in later life. Methods: A cross-sectional study (N= 28,245) using data collected by the Belgian Aging Studies was executed. Psychological frailty was measured using the Comprehensive Frailty Assessment Instrument, more specifically mood-disorders and emotional loneliness. Chi square tests were used to investigate the relation between psychological frailty and socioeconomic indicators. In order to get an insight into the hierarchical order of the predictors of high psychological frailty, a Chi-squared Automatic Interaction Detector (CHAID)-analysis was applied. Results: The risk factors for high psychological frailty were: female, not having a partner, low education and inadequate financial resources. Concerning gender, high psychologically frail women were more often widowed, had no partner and had a lower educational and income level than high psychologically frail men. Results of CHAID analyzes, showed that being divorced or widow(ed), and having difficulties to make ends meet and being a woman were the best predictors for high psychological frailty in community dwelling older people. Conclusion: Asking if there are difficulties to make ends meet enables to detect community dwelling psychological frail older people.

Capabilities of older people in adjusting to frailty

Introduction: External factors influence older people’s changes to successfully age in place, as do intrapersonal factors, which allow people to adjust to changes in daily life. Although research on active and healthy ageing has shown the importance of a multidisciplinary perspective, less thought has been given to the direct environment an ageing person spends his time in. Additionally, research about psychosocial experiences has mainly focused on frailty as a physical concept without taking the subjective perspective into account. Research was seldom directed at the older people as care receivers, but at the perspective of formal care. Consequently, this study starts where others ended, namely in addressing home-dwelling older people themselves, by examining how they cope with current and future frailty. Methods: The technique of focus group interviews N=137 older people was used and data was collected through a semi-structered questionnaire on place and care. The transcripts were thematically and narratively analysed by an iterative coding proces based on the coping model of Duner & Nordstrom 2 and the conceptualisation of frailty by De Witte et al. 1. Results: Our analysis identified an additional managing style of ‘rejective managing’ next to the three styles suggested by Duner & Nordstrom 2: 1 active, 2 adaptive, and 3 passive. As the way older people act on their changing situations can be defined on their degree of dependency and their degree of activeness, the study unfolds that both dimensions are not necessarily correlated with what was stated by Duner and Nordstrom 2, as rejective older people are independent and do not act. Discussion: Managing styles and frailty dimensions become dynamic as managing one dimension of frailty leads to managing other dimensions i.e. spillover effect, and as active managing enables even more activeness i.e. amplifying effect. Moreover, the need for care and support of older people varies according to frailty and managing styles. Conclusion: The study identifies subjective factors influencing the relationship between the individual and the environment. How people act on frailty underpins not only the ability to manage specific changes but also depicts the intertwining relation between the different dimensions of frailty. Lessons learned: Definition of management capabilities; Identification of managing styles; Introduction of an empowering perspective in frailty literature; and Creation of a tool to guide policy and practice in empowering frail people. Limitations: The narratives were approached in a positive way, which could enable emphasising a more active managing style rather then rejecting managing. Additionally, ‘categorisation’ neglects the interchangeability between the person and the environment. Suggestions for future research: A longitudinal multilevel study is suggested to get a comprehensive understanding of the dynamic process between managing styles and multi-dimensional frailty, as is repeating the study in other environments to assess and compare contexts.

Hopelessness, life dissatisfaction and boredom among older people.

Identifying frail older people, and in particular, people who are psychologically frail in a community setting is difficult. This article investigates predictors of psychological frailty and constructs a short and effective pre-detection tool for highly psychologically frail older people. The Belgian Ageing Studies, a cross-sectional study (n=28.245) was used. Measures included four items of the Geriatric Depression Scale, the psychological domain of the Comprehensive Frailty Assessment Instrument. First bivariate analyses were used. Afterwards, Chi-squared automatic interaction detector (CHAID) analysis was applied to gain an insight into the hierarchical order of predictors for high psychological frailty. Findings indicate that the combination of hopelessness and life dissatisfaction predicts high psychological frailty in 68.4% of cases. Early detection of frailty offers opportunities to start early interventions, and can delay or reduce frailty. In order to detect older people who are psychologically frail, a simple two question pre-detection tool was developed. To conclude: if a patient answers 'yes' to feeling hopeless and 'no' to having life satisfaction, this predicts with great probability (68.4%) high psychological frailty.

Can proxy assessments serve as a first screener for identifying people at risk for multidimensional frailty?

PurposeTimely detection of multidimensional frailty is important to prevent further negative outcomes. Perspectives of general practitioners (GPs) or informal caregivers might serve as a first, global screener to identify older people in need of a more extended assessment. Therefore, we aimed to investigate whether proxy assessments are associated with older people’s self-reported environmental, physical, psychological, social and overall frailty.MethodsA cross-sectional study was conducted on 78 community-dwelling people aged 60 years and over, their GPs (n = 57) and informal caregivers (n = 50). Self-reported frailty was assessed with the Comprehensive Frailty Assessment Instrument. GPs and informal caregivers rated each frailty domain and overall frailty on a scale of 0 (not frail at all) to 10 (severely frail). Associations between proxy scores and self-reported frailty were examined by correlation analyses.ResultsSignificant low to moderate associations were found between (1) self-reported physical frailty and physical frailty scores given by the GPs (r = 0.366, p ≤ 0.01) and informal caregivers (r = 0.305, p ≤ 0.05), and (2) self-reported psychological frailty and psychological frailty scores given by the GPs (r = 0.230, p ≤ 0.05) and informal caregivers (r = 0.254, p ≤ 0.05). No significant associations were found between proxy scores and self-reported environmental, social and overall frailty.ConclusionsGlobal proxy scores as short, subjective screeners for detecting frailty cannot completely replace self-reported frailty. Nonetheless, low to moderate correlations were found for physical and psychological frailty ratings, suggesting that proxy scores might be of value as a first sign of something being wrong for these domains.