Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Frailty in the Old Age as a Direct Marker of Quality of Life and Health: Gender Differences

  • 53 Accesses

Abstract

Aging of the population emphasizes the need for research on aging-related problems, among which frailty is a key element because of its clinical as well as social implications. After a review of empirical research of frailty in old adults, the objective of this research is fourfold: (1) assess the adequacy of a comprehensive index of frailty; (2) test for the effects of different socioeconomic and anthropometric variables of an index of frailty; (3) study the effect of frailty on quality of life and general health; and (4) prove grounds for potential gender differences in all these concepts surrounding frailty as well as in frailty itself. This study relies on data from the SHARE project at wave 6, with a total of 4498 Spain-dwelling people aged 60 or older (M = 73.56, SD = 8.89), of which 46.1% were male and 53.9% were female. Statistical analyses included Confirmatory Factor Analysis and Full Structural Equation Models with multi-group comparison based upon gender. Results provide evidence of adequacy for this measure of frailty. Evidence shows how different variables have an impact on frailty, which further affects quality of life and health. Finally, gender differences are studied and discussed with previous literature. We conclude that results are consistent with previous literature on frailty in old people. Limitations and future research needs are also presented.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Abizanda, P., López-Torres Hidalgo, J., Romero-Rizos, L., López-Jiménez, M., Sánchez-Jurado, P. M., Atienzar-Núñez, P., et al. (2011). Fragilidad y dependencia en Albacete (estudio FRADEA): Razonamiento, diseño y metodología [Frailty and dependence in Albacete (FRADEA study): rationale, design and methodology]. Revista Española de Geriatría y Gerontología,46(2), 81–88. https://doi.org/10.1016/j.regg.2010.10.004.

  2. Aguilar-Navarro, S. G., Amieva, H., Gutiérrez-Robledo, L. M., & Avila-Funes, J. A. (2015). Frailty among Mexican community-dwelling elderly: a story told 11 years later. The Mexican Health and Aging Study. Salud Pública de México,57(1), S62–S69.

  3. Azzopardi, R. V., Vermeiren, S., Gorus, E., Habbig, A.-K., Petrovic, M., Van Den Noortgate, N., et al. (2016). Linking frailty instruments to the international classification of functioning, disability, and health: A systematic review. Journal of the American Medical Directors Association,17(11), 1066.e1–1066.e11. https://doi.org/10.1016/j.jamda.2016.07.023.

  4. Bandeen-Roche, K., Seplaki, C. L., Huang, J., Buta, B., Kalyani, R. R., Varadhan, R., et al. (2015). Frailty in older adults: A nationally representative profile in the United States. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences,70(11), 1427–1434. https://doi.org/10.1093/gerona/glv133.

  5. Bergman, H., Ferrucci, L., Guralnik, J., Hogan, D. B., Hummel, S., Karunananthan, S., et al. (2007). Frailty: An emerging research and clinical paradigm—issues and controversies. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences,62(7), 731–737. https://doi.org/10.1093/gerona/62.7.731.

  6. Bilotta, C., Bowling, A., Casè, A., Nicolini, P., Mauri, S., Castelli, M., et al. (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 and Quality of Life Outcomes,8(1), 56. https://doi.org/10.1186/1477-7525-8-56.

  7. Blaum, C. S., Xue, Q. L., Michelon, E., Semba, R. D., & Fried, L. P. (2005). The association between obesity and the frailty syndrome in older women: The Women’s Health and Aging Studies. Journal of the American Geriatrics Society,53(6), 927–934. https://doi.org/10.1111/j.1532-5415.2005.53300.x.

  8. Börsch-Supan, A. (2018). Survey of health, ageing and retirement in Europe (SHARE) Wave 6. Release version: 6.1.1. SHARE-ERIC. Data set. https://doi.org/10.6103/share.w6.611.

  9. Börsch-Supan, A., Brandt, M., Hunkler, C., Kneip, T., Korbmacher, J., Malter, F., et al. (2013). Data resource profile: The survey of health, ageing and retirement in Europe (SHARE). International Journal of Epidemiology,42(4), 992–1001. https://doi.org/10.1093/ije/dyt088.

  10. Campbell, A. J., & Buchner, D. M. (1997). Unstable disability and the fluctuations of frailty. Age and Ageing,26(4), 315–318.

  11. Carlos-Gil, A. M., Martínez-Pecino, F., Molina-Linde, J. M., Villegas-Portero, R., Romero-Tabares, A., Aguilar-García, J., et al. (2011). Predictores de fragilidad en el anciano [Predictors of frailty in the elderly]. Revista Multidisciplinar de Gerontología,21(2), 7–21.

  12. Chang, Y. W., Chen, W. L., Lin, F. G., Fang, W. H., Yen, M. Y., Hsieh, C. C., et al. (2012). Frailty and its impact on health-related quality of life: A cross-sectional study on elder community-dwelling preventive health service users. PLoS ONE,7(5), e38079. https://doi.org/10.1371/journal.pone.0038079.

  13. Cheung, G. W., & Rensvold, R. B. (2002). Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling,9(2), 233–255. https://doi.org/10.1207/s15328007sem0902_5.

  14. Collard, R. M., Boter, H., Schoevers, R. A., & Oude-Voshaar, R. C. (2012). Prevalence of frailty in community-dwelling older persons: A systematic review. Journal of the American Geriatrics Society,60(8), 1487–1492. https://doi.org/10.1111/j.1532-5415.2012.04054.x.

  15. De Lepeleire, J., Iliffe, S., Mann, E., & Degryse, J. M. (2009). Frailty: an emerging concept for general practice. British Journal of General Practice,59(562), e177–e182. https://doi.org/10.3399/bjgp09x420653.

  16. Fernandez-Bolaños, M., Otero, A., Zunzunegui, M. V., Beland, F., Alarcón, T., de Hoyos, C., et al. (2008). Sex differences in the prevalence of frailty in a population aged 75 and older in Spain. Journal of the American Geriatrics Society,56(12), 2370–2371. https://doi.org/10.1111/j.1532-5415.2008.02032.x.

  17. Finney, S. J., & DiStefano, C. (2013). Nonnormal and categorical data in structural equation modeling. In G. R. Hancock & R. O. Mueller (Eds.), Structural equation modeling: A second course (pp. 439–492). Charlotte: IAP Information Age Publishing.

  18. Foreman, K. J., Marquez, N., Dolgert, A., Fukutaki, K., Fullman, N., McGaughey, M., et al. (2018). Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories. The Lancet. https://doi.org/10.1016/s0140-6736(18)31694-5.

  19. Fougère, B., Kelaiditi, E., Hoogendijk, E. O., Demougeot, L., Duboué, M., Vellas, B., et al. (2016). Frailty index and quality of life in nursing home Residents: results from INCUR study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences,71(3), 420–424. https://doi.org/10.1093/gerona/glv098.

  20. Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., et al. (2001). Frailty in older adults: Evidence for a phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences,56(3), M146–M157. https://doi.org/10.1093/gerona/56.3.m146.

  21. Gale, C. R., Cooper, C., Deary, I. J., & Aihie-Sayer, A. (2014). Psychological well-being and incident frailty in men and women: the English Longitudinal Study of Ageing. Psychological Medicine,44(04), 697–706. https://doi.org/10.1017/s0033291713001384.

  22. García-García, F. J., & Alfaro-Acha, A. (2010). Fragilidad: de la epidemiología a la clínica [Frailty: from the epidemiology to the clinic]. Revista Española de Geriatría y Gerontología,45(5), 250–251. https://doi.org/10.1016/j.regg.2010.05.007.

  23. Garre-Olmo, J., Calvó-Perxas, L., López-Pousa, S., de Gracia Blanco, M., & Vilalta-Franch, J. (2013). Prevalence of frailty phenotypes and risk of mortality in a community-dwelling elderly cohort. Age and Ageing,42(1), 46–51. https://doi.org/10.1093/ageing/afs047.

  24. Gill, T. M., Gahbauer, E. A., Allore, H. G., & Han, L. (2006). Transitions between frailty states among community-living older persons. Archives of Internal Medicine,166(4), 418. https://doi.org/10.1001/archinte.166.4.418.

  25. Gobbens, R. J., Luijkx, K. G., & van Assen, M. A. (2012). Explaining quality of life of older people in the Netherlands using a multidimensional assessment of frailty. Quality of Life Research,22(8), 2051–2061. https://doi.org/10.1007/s11136-012-0341-1.

  26. Gobbens, R. J., & van Assen, M. A. (2014). The prediction of quality of life by physical, psychological and social components of frailty in community-dwelling older people. Quality of Life Research,23(8), 2289–2300. https://doi.org/10.1007/s11136-014-0672-1.

  27. Godin, J., Armstrong, J. J., Wallace, L., Rockwood, K., & Andrew, M. K. (2018). The impact of frailty and cognitive impairment on quality of life: Employment and social context matter. International Psychogeriatrics. https://doi.org/10.1017/s1041610218001710.

  28. Hoogendijk, E. O., van Hout, H. P. J., Heymans, M. W., van der Horst, H. E., Frijters, D. H. M., Broese van Groenou, M. I., et al. (2014). Explaining the association between educational level and frailty in older adults: Results from a 13-year longitudinal study in the Netherlands. Annals of Epidemiology,24(7), 538–544.e2. https://doi.org/10.1016/j.annepidem.2014.05.002.

  29. Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling,6(1), 1–55.

  30. Hubbard, R. E., Goodwin, V. A., Llewellyn, D. J., Warmoth, K., & Lang, I. A. (2014). Frailty, financial resources and subjective well-being in later life. Archives of Gerontology and Geriatrics,58(3), 364–369. https://doi.org/10.1016/j.archger.2013.12.008.

  31. Hyde, M., Wiggins, R. D., Higgs, P., & Blane, D. B. (2003). A measure of quality of life in early old age: The theory, development and properties of a needs satisfaction model (CASP-19). Aging & Mental Health,7(3), 186–194. https://doi.org/10.1080/1360786031000101157.

  32. Iriarte, E., & Araya, A. X. (2016). Criterios de fragilidad en personas mayores que viven en la comunidad: Una actualización de la literatura [Frailty criteria among older people living in the community: An update]. Revista Médica de Chile,144(11), 1440–1447. https://doi.org/10.4067/S0034-98872016001100010.

  33. Kline, R. B. (2015). Principles and practice of structural equation modeling. New York: Guilford Press.

  34. Kojima, G., Iliffe, S., Jivraj, S., & Walters, K. (2016). Association between frailty and quality of life among community-dwelling older people: A systematic review and meta-analysis. Journal of Epidemiology and Community Health,70(7), 716–721. https://doi.org/10.1136/jech-2015-206717.

  35. Koller, K., & Rockwood, K. (2013). Frailty in older adults: Implications for end-of-life care. Cleveland Clinic Journal Of Medicine,80(3), 168–174. https://doi.org/10.3949/ccjm.80a.12100.

  36. Langlois, F., Vu, T. T. M., Kergoat, M. J., Chassé, K., Dupuis, G., & Bherer, L. (2012). The multiple dimensions of frailty: Physical capacity, cognition, and quality of life. International Psychogeriatrics,24(09), 1429–1436. https://doi.org/10.1017/s1041610212000634.

  37. Lenardt, M. H., Carneiro, N. H. K., Binotto, M. A., Willig, M. H., Lourenço, T. M., & Albino, J. (2016). Fragilidade e qualidade de vida de idosos usuários da atenção básica de saúde [Frailty and quality of life in older users of basic healthcare]. Revista Brasileira de Enfermagem,69(3), 478–483. https://doi.org/10.1590/0034-7167.2016690309i.

  38. Li, C. H. (2016). Confirmatory factor analysis with ordinal data: Comparing robust maximum likelihood and diagonally weighted least squares. Behavior Research Methods,48(3), 936–949. https://doi.org/10.3758/s13428-015-0619-7.

  39. Lin, C. C., Li, C. I., Chang, C. K., Liu, C. S., Lin, C. H., Meng, N. H., et al. (2011). Reduced health-related quality of life in elders with frailty: A cross-sectional study of community-dwelling elders in Taiwan. PLoS ONE,6(7), e21841. https://doi.org/10.1371/journal.pone.0021841.

  40. Macklai, N. S., Spagnoli, J., Junod, J., & Santos-Eggimann, B. (2013). Prospective association of the SHARE-operationalized frailty phenotype with adverse health outcomes: Evidence from 60 + community-dwelling Europeans living in 11 countries. BMC Geriatrics,13, 3.

  41. Malter, F., & Börsch-Supan, A. (Eds.). (2017). SHARE wave 6: Panel innovations and collecting Dried Blood Spots. Munich: Munich Center for the Economics of Aging (MEA).

  42. Marsh, H. W., Hau, K. T., & Wen, Z. (2004). In search of golden rules: Comment on hypothesis-testing approaches to setting cutoff values for fit indexes and dangers in overgeneralizing Hu and Bentler’s findings. Structural Equation Modeling,11(3), 320–341.

  43. Masel, M. C., Graham, J. E., Reistetter, T. A., Markides, K. S., & Ottenbacher, K. J. (2009). Frailty and health related quality of life in older Mexican Americans. Health and Quality of Life Outcomes,7(1), 70. https://doi.org/10.1186/1477-7525-7-70.

  44. Morley, J. E., Vellas, B., Abellan van Kan, G., Anker, S. D., Bauer, J. M., Bernabei, R., et al. (2013). Frailty consensus: A call to action. Journal of the American Medical Directors Association,14(6), 392–397. https://doi.org/10.1016/j.jamda.2013.03.022.

  45. Mulasso, A., Roppolo, M., & Rabaglietti, E. (2014). The role of individual characteristics and physical frailty on health related quality of life (HRQOL): A cross sectional study of Italian community-dwelling older adults. Archives of Gerontology and Geriatrics,59(3), 542–548. https://doi.org/10.1016/j.archger.2014.08.012.

  46. Muthén, L. K., & Muthén, B. O. (1998–2012). Mplus User’s Guide (7th ed.). Los Angeles, CA: Muthén & Muthén.

  47. Orueta-Sánchez, R., Rodríguez-de Cossío, A., Carmona-de la Morena, J., Moreno-Álvares-Vijande, A., García-López, A., & Pintor-Córdoba, C. (2008). Anciano frágil y calidad de vida [Frail elderly people and quality of life]. Revista Clínica de Medicina de Familia,2(3), 101–105.

  48. Renne, I., & Gobbens, R. J. (2018). Effects of frailty and chronic diseases on quality of life in Dutch community-dwelling older adults: A cross-sectional study. Clinical Interventions in Aging,13, 325–334. https://doi.org/10.2147/cia.s156116.

  49. Rietman, M. L., van der A, D. L., van Oostrom, S. H., Picavet, H. S. J., Dollé, M. E. T., van Steeg, H., et al. (2018). The association between BMI and different frailty domains: A U-shaped curve? The Journal of Nutrition, Health & Aging,22(1), 8–15. https://doi.org/10.1007/s12603-016-0854-3.

  50. Rockwood, K., Howlett, S. E., MacKnight, C., Beattie, B. L., Bergman, H., Hébert, R., et al. (2004). Prevalence, attributes, and outcomes of fitness and frailty in community-dwelling older adults: Report from the Canadian Study of Health and Aging. The Journals of Gerontology: Series A: Biological Sciences and Medical Sciences,59(12), 1310–1317. https://doi.org/10.1093/gerona/59.12.1310.

  51. Romero-Ortuño, R. (2011). The frailty instrument for primary care of the Survey of Health, Ageing and Retirement in Europe (SHARE-FI) predicts mortality beyond age, comorbidities, disability, self-rated health, education and depression. European Geriatric Medicine,2, 323.

  52. Romero-Ortuño, R. (2014). Frailty Index in Europeans: Association with determinants of health. Geriatrics & Gerontology International,14(2), 420–429. https://doi.org/10.1111/ggi.12122.

  53. Romero-Ortuño, R., Walsh, C. D., Lawlor, B. A., & Kenny, R. A. (2010). A frailty instrument for primary care: Findings from the Survey of Health, Ageing and Retirement in Europe (SHARE). BMC Geriatrics,10, 57. https://doi.org/10.1186/1471-2318-10-57.

  54. Santos-Eggimann, B., Cuenoud, P., Spagnoli, J., & Junod, J. (2009). Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences,64A(6), 675–681. https://doi.org/10.1093/gerona/glp012.

  55. Shamliyan, T., Talley, K. M., Ramakrishnan, R., & Kane, R. L. (2013). Association o f frailty with survival: A systematic literature review. Ageing Research Reviews,12(2), 719–736. https://doi.org/10.1016/j.arr.2012.03.001.

  56. Song, X., Mitnitski, A., & Rockwood, K. (2010). Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. Journal of the American Geriatrics Society,58(4), 681–687. https://doi.org/10.1111/j.1532-5415.2010.02764.x.

  57. Sousa, A. C. P., Dias, R. C., Maciel, Á. C. C., & Guerra, R. O. (2012). Frailty syndrome and associated factors in community-dwelling elderly in Northeast Brazil. Archives of Gerontology and Geriatrics,54(2), e95–e101. https://doi.org/10.1016/j.archger.2011.08.010.

  58. Sutton, J. L., Gould, R. L., Daley, S., Coulson, M. C., Ward, E. V., Butler, A. M., et al. (2016). Psychometric properties of multicomponent tools designed to assess frailty in older adults: A systematic review. BMC Geriatrics,16, 1. https://doi.org/10.1186/s12877-016-0225-2.

  59. van de Schoot, R., Lugtig, P., & Hox, J. (2012). A checklist for testing measurement invariance. European Journal of Developmental Psychology,9(4), 486–492. https://doi.org/10.1080/17405629.2012.686740.

  60. Von dem Knesebeck, O., Hyde, M., Higgs, P., Kupfer, A., & Siegrist, J. (2005). Quality of life and wellbeing. In A. Börsch-Supan, A. Brugiavini, H. Jürges, J. Mackenbach, J. Siegrist, & G. Weber (Eds.), Health, ageing and retirement in Europe—First results from the survey of health, ageing and retirement in Europe. Mannheim: Mannheim Research Institute for the Economics of Aging (MEA).

  61. Ware, J. E., & Gandek, B. (1998). Overview of the SF-36 health survey and the international quality of life assessment (IQOLA) project. Journal of Clinical Epidemiology,51(11), 903–912.

  62. Wu, T. Y., Chie, W. C., Kuo, K. L., Wong, W. K., Liu, J. P., Chiu, S. T., et al. (2013). Quality of life (QOL) among community dwelling older people in Taiwan measured by the CASP-19, an index to capture QOL in old age. Archives of Gerontology and Geriatrics,57(2), 143–150. https://doi.org/10.1016/j.archger.2013.03.010.

  63. Yu, R., Wong, M., Chong, K. C., Chang, B., Lum, C. M., Auyeung, T. W., et al. (2018). Trajectories of frailty among Chinese older people in Hong Kong between 2001 and 2012: an age-period-cohort analysis. Age and Ageing,47(2), 254–261. https://doi.org/10.1093/ageing/afx170.

Download references

Acknowledgements

The Authors want to thank the Survey of Health, Aging and Retirement in Europe (SHARE). The SHARE data collection has been primarily funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812) and FP7 (SHARE-PREP: No211909, SHARE-LEAP: No227822, SHARE M4: No261982). Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the U.S. National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C) and from various national funding sources is gratefully acknowledged (see www.share-project.org). This research has been partially funded by Spanish Ministry of Science, Innovation & Universities, “Social Challenges Program” [RTI2018-093321-B-100]. Also by the Special Actions program from the Vice-Chancellor of Research, University of Valencia, [AE18-777619]. Dr. Trinidad Sentandreu-Mañó, Dr. Laura Badenes, Prof. Amparo Oliver, Prof. José M. Tomás and Irene Fernández are part of the research group Advanced Research Methods Applied to Quality of Life promotion (ARMAQoL), from the University of Valencia. Additionally, all these coauthors, together with Dr. Deborah J. Burks, belong to the Biogender Unit composed of the University of Valencia and Príncipe Felipe Research Center.

Author information

Correspondence to Irene Fernández.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sentandreu-Mañó, T., Badenes-Ribera, L., Fernández, I. et al. Frailty in the Old Age as a Direct Marker of Quality of Life and Health: Gender Differences. Soc Indic Res (2019). https://doi.org/10.1007/s11205-019-02246-1

Download citation

Keywords

  • Old adults
  • Frailty
  • Quality of life
  • Health
  • Gender differences