Reduced Health-Related Quality of Life in Elders with Frailty: A Cross-Sectional Study of Community-Dwelling Elders in Taiwan

Abstract

PurposeExploring the domains and degrees of health-related quality of life (HRQOL) that are affected by the frailty of elders will help clinicians understand the impact of frailty. This association has not been investigated in community-dwelling elders. Therefore, we examined the domains and degree of HRQOL of elders with frailty in the community in Taiwan.MethodsA total of 933 subjects aged 65 years and over were recruited in 2009 from a metropolitan city in Taiwan. Using an adoption of the Fried criteria, frailty was defined by five components: shrinking, weakness, poor endurance and energy, slowness, and low physical activity level. HRQOL was assessed by the short form 36 (SF-36). The multiple linear regression model was used to test the independent effects of frailty on HRQOL.ResultsAfter multivariate adjustment, elders without frailty reported significantly better health than did the pre-frail and frail elders on all scales, and the pre-frail elders reported better health than did the frail elders for all scales except the scales of role limitation due to physical and emotional problems and the Mental Component Summary (MCS). The significantly negative differences between frail and robust elders ranged from 3.58 points for the MCS to 22.92 points for the physical functioning scale. The magnitude of the effects of frail components was largest for poor endurance and energy, and next was for slowness. The percentages of the variations of these 10 scales explained by all factors in the models ranged from 11.1% (scale of role limitation due to emotional problems) to 49.1% (scale of bodily pain).ConclusionsOur study demonstrates that the disabilities in physical health inherent in frailty are linked to a reduction in HRQOL. Such an association between clinical measures and a generic measure of the HRQOL may offer clinicians new information to understand frailty and to conceptualize it within the broader context of disability.

Pain in older people with frailty

“…We identified seven studies which reported pain outcomes in older people with frailty (table 1). One study was conducted in Canada 11,17 , one in Australia 18,19 , one in Finland 20 , two in Taiwan 13,21 , and two in Brazil 22,23 . The mean age of participants ranged from 71 years to 82 years (see table 1).…”

“…The proportion of frail participants ranged in the studies from 9% to 32%. Four studies used questions from the SF-12 or SF-36 to assess pain 11,13,19,23 . Chang et al 21 reported the presence of pain history but did not report the specific measure.…”

“…The remaining studies recruited older people without specific conditions. Three studies reported pain intensity 13,20,23 .…”

“…These are mostly self-report measures that typically include the identification of the pain site(s); pain intensity; descriptors to capture the sensory and affective components of pain; and an assessment of the impact on quality of life or intrusiveness such as interference with work inside and outside of the home. Pain is a significant, often unmet need in older people which can impact on their quality of life and mood 13,14 . Understanding pain in older people with frailty is an important first step towards developing appropriate interventions specifically for this population.…”

Qualidade de vida do idoso fragilizado e institucionalizado

“…reducing the quality of life level. (9) In addition, as a result of the institutionalization, these effects can be enhanced.…”