Skip to main content
SpringerLink
Log in

Are physically frail older persons more at risk of adverse outcomes if they also suffer from cognitive, social, and psychological frailty?

  • Original Investigation
  • Published:
European Journal of Ageing Aims and scope Submit manuscript

Abstract

Frailty is considered a predictor for negative outcomes such as disability, decreased quality of life, and hospital admission. Frailty measures have been developed that include different dimensions. We examined whether people who are physically frail are more at risk for negative outcomes of frailty if they also suffer from psychological, cognitive, or social frailty. Frailty was measured at baseline by means of the Groningen Frailty Indicator (GFI), which comprises a physical, cognitive, social, and psychological dimension. Only frail persons were included in the study (GFI ≥ 5) that, in addition, had to be frail in the physical dimension (i.e., ≥1 on this dimension). IADL disability and quality of life were measured at baseline and at 12 months. Hospital admission was assessed during this period. In this, physically frail sample effects of the other three frailty dimensions were studied in regression models. The sample (n = 334, mean age 78.1, and range 70–92) included 40.1 % frail men and 59.9 % frail women. Overall, no additional effects for the cognitive, social, or psychosocial dimensions were found: other frailty dimensions did not have an additional impact on disability, quality of life, or hospital admission in people who already suffered from physical frailty. Higher scores of physical frailty were significantly related to IADL disability (p < 0.05) and hospital admission (p < 0.05). Additional analysis showed that the physical frailty score predicted IADL disability and hospital admission better than the GFI overall score. Results of this study suggest that persons, who are physically frail, according to the GFI, are not more at risk for negative outcomes of frailty (i.e., IADL disability, decreased quality of life, and hospital admission) if they in addition suffer from cognitive, social, or psychological frailty. In addition, for the prediction of IADL disability or hospital admission, the focus for screening should be on the physical frailty score instead of the GFI overall score including different dimensions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Ament BH, de Vugt ME, Koomen FM, Jansen MW, Verhey FR, Kempen GI (2012) Resources as a protective factor for negative outcomes of frailty in elderly people. Gerontology 58(5):391–397

    Article  Google Scholar 

  • Barreto PS (2012) Participation bias in postal surveys among older adults: the role played by self-reported health, physical functional decline and frailty. Arch Gerontol Geriat 55(3):592–598

    Article  Google Scholar 

  • Bilotta C, Bowling A, Case A, Nicolini P, Mauri S, Castelli M, Vergani C (2010) Dimensions and correlates of quality of life according to frailty status: a cross-sectional study on community-dwelling older adults referred to an outpatient geriatric service in Italy. Health Qual Life Out 8:56

    Article  Google Scholar 

  • Bowling A (2005) Mode of questionnaire administration can have serious effects on data quality. J Public Health-Uk 27(3):281–291

    Google Scholar 

  • Buchner DM, Wagner EH (1992) Preventing frail health. Clin Geriatr Med 8(1):1–17

    Google Scholar 

  • Campbell AJ, Buchner DM (1997) Unstable disability and the fluctuations of frailty. Age Ageing 26(4):315–318

    Article  Google Scholar 

  • Comette P, D’Hoore W, Malhomme B, Van Pee D, Meert P, Swine C (2005) Differential risk factors for early and later hospital readmission of older patients. Aging Clin Exp Res 17(4):322–328

    Article  Google Scholar 

  • Covinsky KE, Palmer RM, Counsell SR, Pine ZM, Walter LC, Chren MM (2000) Functional status before hospitalization in acutely ill older adults: validity and clinical importance of retrospective reports. J Am Geriatr Soc 48(2):164–169

    Google Scholar 

  • Daniels R, van Rossum E, Beurskens A, van den Heuvel W, de Witte L (2012) The predictive validity of three self-report screening instruments for identifying frail older people in the community. BMC Public Health 12:69

    Article  Google Scholar 

  • de Vries NM, Staal JB, van Ravensberg CD, Hobbelen JS, Olde Rikkert MG, Nijhuis-van der Sanden MW (2011) Outcome instruments to measure frailty: a systematic review. Ageing Res Rev 10(1):104–114

    Article  Google Scholar 

  • Fairhall N, Aggar C, Kurrle SE, Sherrington C, Lord S, Lockwood K, Monaghan N, Cameron ID (2008) Frailty intervention trial (FIT). BMC Geriatr 8:27

    Article  Google Scholar 

  • Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A 56(3):M146–M156

    Article  Google Scholar 

  • Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G (2004) Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A 59(3):255–263

    Article  Google Scholar 

  • Gill TM, Allore HG, Hardy SE, Guo Z (2006) The dynamic nature of mobility disability in older persons. J Am Geriatr Soc 54(2):248–254

    Article  Google Scholar 

  • Gobbens RJ, Luijkx KG, Wijnen-Sponselee MT, Schols JM (2007) Frail elderly. Identification of a population at risk. Tijdschr Gerontol Geriatr 38(2):65–76

    Article  Google Scholar 

  • Gobbens RJ, van Assen MA, Luijkx KG, Wijnen-Sponselee MT, Schols JM (2010) The Tilburg Frailty Indicator: psychometric properties. J Am Med Dir Assoc 11(5):344–355

    Article  Google Scholar 

  • Gobbens RJ, van Assen MA, Luijkx KG, Schols JM (2012) The predictive validity of the Tilburg Frailty Indicator: disability, health care utilization, and quality of life in a population at risk. Gerontologist 55(2):369–379

    Google Scholar 

  • Hamerman D (1999) Toward an understanding of frailty. Ann Intern Med 130(11):945–950

    Article  Google Scholar 

  • Hebert R, Bravo G, Korner-Bitensky N, Voyer L (1996) Refusal and information bias associated with postal questionnaires and face-to-face interviews in very elderly subjects. J Clin Epidemiol 49(3):373–381

    Article  Google Scholar 

  • Hoogendoorn M, van Wetering CR, Schols AM, van Rutten-Molken MP (2009) Self-report versus care provider registration of healthcare utilization: impact on cost and cost-utility. Int J Technol Assess 25(4):588–595

    Article  Google Scholar 

  • Katz S, Downs TD, Cash HR, Grotz RC (1970) Progress in development of the index of ADL. Gerontologist 10(1):20–30

    Article  Google Scholar 

  • King J, Yourman L, Ahalt C, Eng C, Knight SJ, Perez-Stable EJ, Smith AK (2012) Quality of life in late-life disability: “I don’t feel bitter because I am in a wheelchair”. J Am Geriatr Soc 60(3):569–576

    Article  Google Scholar 

  • Landi F, Onder G, Cesari M, Barillaro C, Lattanzio F, Carbonin PU, Bernabei R (2004) Comorbidity and social factors predicted hospitalization in frail elderly patients. J Clin Epidemiol 57(8):832–836

    Article  Google Scholar 

  • Markle-Reid M, Browne G (2003) Conceptualizations of frailty in relation to older adults. J Adv Nurs 44(1):58–68

    Article  Google Scholar 

  • Metzelthin SF, Daniels R, van Rossum E, de Witte L, van den Heuvel WJ, Kempen GI (2010a) The psychometric properties of three self-report screening instruments for identifying frail older people in the community. BMC Public Health 10:176

    Article  Google Scholar 

  • Metzelthin SF, van Rossum E, de Witte LP, Hendriks MR, Kempen GI (2010b) The reduction of disability in community-dwelling frail older people: design of a two-arm cluster randomized controlled trial. BMC Public Health 10:511

    Article  Google Scholar 

  • Mitnitski AB, Mogilner AJ, Rockwood K (2001) Accumulation of deficits as a proxy measure of aging. Sci World J 1:323–336

    Article  Google Scholar 

  • Raphael D, Cava M, Brown I, Renwick R, Heathcote K, Weir N, Wright K, Kirwan L (1995) Frailty: a public health perspective. Can J Public Health 86(4):224–227

    Google Scholar 

  • Rockwood K, Fox RA, Stolee P, Robertson D, Beattie BL (1994) Frailty in elderly people: an evolving concept. Can Med Assoc J 150(4):489–495

    Google Scholar 

  • Schuurmans H, Steverink N, Lindenberg S, Frieswijk N, Slaets JP (2004) Old or frail: what tells us more? J Gerontol A 59(9):M962–M965

    Article  Google Scholar 

  • Short ME, Goetzel RZ, Pei X, Tabrizi MJ, Ozminkowski RJ, Gibson TB, Dejoy DM, Wilson MG (2009) How accurate are self-reports? Analysis of self-reported health care utilization and absence when compared with administrative data. J Occup Environ Med 51(7):786–796

    Article  Google Scholar 

  • Slaets JP (2006) Vulnerability in the elderly: frailty. Med Clin N Am 90:593–601

    Article  Google Scholar 

  • Steverink N, Slaets JPJ, Schuurmans H, Van Lis M (2001) Measuring frailty. Development and testing of the Groningen Frailty Indicator (GFI). Gerontologist 41:236–237

    Google Scholar 

  • Strawbridge WJ, Shema SJ, Balfour JL, Higby HR, Kaplan GA (1998) Antecedents of frailty over three decades in an older cohort. J Gerontol B 53(1):S9–S16

    Article  Google Scholar 

  • Studenski S, Hayes RP, Leibowitz RQ, Bode R, Lavery L, Walston J, Duncan P, Perera S (2004) Clinical global impression of change in physical frailty: development of a measure based on clinical judgment. J Am Geriatr Soc 52(9):1560–1566

    Article  Google Scholar 

  • van den Brink M, van den Hout WB, Stiggelbout AM, van de Velde CJ, Kievit J (2004) Cost measurement in economic evaluations of health care: whom to ask? Med Care 42(8):740–746

    Article  Google Scholar 

  • Verbrugge LM, Jette AM (1994) The disablement process. Soc Sci Med 38(1):1–14

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank the patients for their willingness to participate in the present study. The Centre for Data and Information Management (MEMIC) at Maastricht University is acknowledged for their assistance in the data collection. This research was conducted as part of a study that was funded by ZonMw—the Netherlands Organization for Health Research and Development (Grant 311070201).

Author information

Authors and Affiliations

  1. Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands

    Bart H. L. Ament & Gertrudis I. J. M. Kempen

  2. Alzheimer Centre Limburg, MHeNS School for Mental Health and NeuroScience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands

    Bart H. L. Ament, Marjolein E. de Vugt & Frans R. J. Verhey

Authors
  1. Bart H. L. Ament
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marjolein E. de Vugt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Frans R. J. Verhey
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gertrudis I. J. M. Kempen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bart H. L. Ament.

Additional information

Responsible Editor: Dorly J. H. Deeg.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ament, B.H.L., de Vugt, M.E., Verhey, F.R.J. et al. Are physically frail older persons more at risk of adverse outcomes if they also suffer from cognitive, social, and psychological frailty?. Eur J Ageing 11, 213–219 (2014). https://doi.org/10.1007/s10433-014-0308-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10433-014-0308-x

Keywords

Search

Navigation