Psychosocial determinants of frailty among older adults in Singapore: a community-based survey

Abstract

Background With increasing life expectancy, it is important to understand the role of non-physical aspects of health in frailty prevention. The study aimed to examine how multiple dimensions of mental and social health, in addition to physical health, were associated with frailty in the population of older adults. Methods A cross-sectional door-to-door survey was conducted with 497 older adults in Singapore. Frailty was assessed using the FRAIL scale. Physical health was assessed by multimorbidity and physical activity; social health by the Lubbens’ Social Network Scale, Community Integration Measure and UCLA loneliness scale; and mental health by the three-factor of the General Health Questionnaire (GHQ): anxiety/depression, loss of confidence and social dysfunction. Hierarchical ordinal regression was conducted to identify independent predictors of frailty, adjusting for socio-demographic variables. Results Compared to robust (59.5%) and pre-frail (32.6%) older adults, frail adults (7.9%) reported higher morbidity, lower physical activity, higher scores on all three subscales of GHQ, and had lower scores on all three social health scales that were assessed. In multiple regression model, frailty was significantly associated with 81–90 years old (adj. OR = 3.04), having 2–3 (adj. OR = 1.63) or > 3 (adj. OR = 2.01) chronic diseases, social dysfunction in GHQ (adj. OR = 4.31), and loneliness (adj. OR = 1.26). Physical activity did not remain significantly associated with frailty when mental and social health-related factors were entered in the regression. Conclusions The study findings highlight the importance of community intervention in mental and social health among older adults to prevent frailty in later life. Healthy aging is only possible when older adults’ psychosocial needs are addressed.