Background
Methods
Design and setting
Inclusion criteria
Frailty, Tilburg Frailty Indicator (TFI)
Health aspects
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Health perception is analysed in three categories; excellent/very good, good and reasonable/badNumber of conditions; ranging from zero up to eleven. The participants were asked to check the box when they had one or more of the following diseases or conditions in the past 12 months: diabetes, stroke, heart failure, cancer, asthma or other lung problems, incontinence, joint wear, depression, anxiety or panic disorder, dementia, hearing problems and vision problems.
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Activities of daily living (ADL), KATZ
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To assess the level of both basic and instrumental activities of daily living, the KATZ-15, also known as the Modified Katz ADL, was used. This instrument was established as internally consistent (KR-20 = 0.8) and strongly associated with quality of life measures [30]. The instrument includes 15 items and a total score on the 15 items was calculated, the higher the score, the more problems with the ADL are present. When two or more items were missing, the respondents were left out of the analyses.
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Home care and informal care
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Usage of home care and informal care were analysed using the following questions at which the respondents could answer ‘yes’ or ‘no’:
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‘Do you use home care? For example, a district nurse or help at home‘
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‘Do you have someone who voluntarily helps or supports you for a longer period of time? (informal care provider)’
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Wellbeing aspects
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Quality of life, the respondents graded their quality of life and compared to a year ago (much better, little better, the same, little worse, much worse).
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Loneliness, loneliness was assessed using the loneliness scale of de Jong-Gierveld with a 3-point likert scale and a reliability of Cronbach’s α = 0.80 up to 0.90 [27]. The loneliness scale has 11 items and a total score on the 11 items was calculated, analyses were done with the total score as continuous variable. When two or more items were missing, the respondents were left out of the analyses. To create the imputed data file loneliness was used as a categorical variable to lower the number of parameters; not lonely (score 0, 1 or 2), moderate lonely (score 3 through 8), severe lonely (score 9 or 10), and very severe lonely (score 11).
Going outside; daily, few times per week, few times per month, less than once a month
Meeting the children, grandchildren, family, friends and neighbours; every week, once or twice per month, less/seldom, never, not applicable
Statistical analysis
Results
Missing value analysis
Background characteristics
Frailty
Item | Yes (%) | No (%) | Sometimes (%) | Missing (%) |
---|---|---|---|---|
Physical frailty | ||||
1 Poor physical health | 1010 (57.1) |
663 (37.5)*
| NA | 95 (5.4) |
2 Unexplained weight loss |
161 (9.1)
| 1506 (85.2) | NA | 101 (5.7) |
3 Difficulty in walking |
800 (45.2)
| 725 (41.0) | NA | 243 (13.7) |
4 Difficulty maintaining balance |
517 (29.2)
| 853 (48.2) | NA | 398 (22.5) |
5 Poor hearing |
465 (26.3)
| 906 (51.2) | NA | 397 (22.5) |
6 Poor vision |
331 (18.7)
| 980 (55.4) | NA | 457 (25.8) |
7 Strength in hands |
544 (30.8)
| 840 (47.5) | NA | 384 (21.7) |
8 Physical tiredness |
777 (43.9)
| 694 (39.3) | NA | 297 (16.8) |
Psychological frailty | ||||
9 Problems with memory |
114 (6.4)
| 982 (55.5) | 609 (34.4) | 63 (3.6) |
10 Feeling down |
152 (8.6)
| 873 (49.4) |
670 (37.9)
| 73 (4.1) |
11 Feeling nervous or anxious |
136 (7.7)
| 995 (56.3) |
577 (32.6)
| 60 (3.4) |
12 Able to cope with problems | 1426 (80.7) |
263 (14.9)
| NA | 79 (4.5) |
Social frailty | ||||
13 Living alone |
1138 (64.4)
| 585 (33.1) | NA | 45 (2.5) |
14 Social relations |
393 (22.2)
| 758 (42.9) |
565 (32.0)
| 52 (2.9) |
15 Social support | 1406 (79.5) |
285 (16.1)
| NA | 77 (4.4) |
Background characteristics | Total n = 1768 Respondents (%/SD) | Missing (%) | 0 n = 550 (31.1%) | 1 n = 147 (8.3%) | 2 n = 132 (7.5%) | 3 n = 325 (18.4%) | 4 n = 107 (6.1%) | 5 n = 100 (5.7%) | 6 n = 225 (12.7%) | 7 n = 182 (10.3%) |
---|---|---|---|---|---|---|---|---|---|---|
Mean Age (SD)** Range: 65–99 | 78.7 (6.4) | 35 (2.0) | 78.19 (6.2) | 80.86 (6.2) | 78.22 (6.0) | 78.83 (6.3) | 78.33 (6.7) | 80.44 (6.7) | 77.26 (6.3) | 79.67 (6.8) |
Posthoc analysis shows significant differences for: 0–1**, 0–5*, 1–2*, 1–3*, 3–4**, 1–6*, 5–7* | ||||||||||
65–74* | 485 (27.4) | 153 (33.4) | 22 (4.8) | 33 (7.2) | 81 (17.7) | 34 (7.4) | 17 (3.7) | 78 (17.0) | 40 (8.7) | |
75–79 | 464 (26.3) | 153 (33.0) | 36 (7.8) | 39 (8.4) | 84 (18.1) | 23 (5.0) | 26 (5.6) | 55 (11.9) | 48 (10.3) | |
80+ | 811 (45.9) | 232 (28.6) | 87 (10.7) | 57 (7.0) | 153 (18.9) | 48 (5.9) | 54 (6.7) | 87 (10.7) | 93 (11.5) | |
Posthoc analysis shows differences compared to the expected for: 65–74: 1 (−), 6 (+), 80+: 1 (+) | ||||||||||
Gender (female)** | 1221 (69.1) | 0 | 310 (56.4) | 86 (58.5) | 83 (62.9) | 267 (82.8) | 64 (59.8) | 81 (81.0) | 180 (80.0) | 151 (83.0) |
Posthoc analysis shows differences compared to the expected for: male: 0, female: 3,6,7 | ||||||||||
Marital status** | 6 (0.3) | |||||||||
Widowed | 904 (51.1) | 201 (36.5) | 53 (36.1) | 43 (32.6) | 234 (72.0) | 23 (21.5) | 70 (70.0) | 158 (70.2) | 122 (67.0) | |
Married | 573 (32.4) | 265 (48.2) | 86 (58.5) | 76 (57.6) | 20 (6.2) | 73 (68.2) | 6 (6.0) | 22 (9.8) | 25 (13.7) | |
Divorced | 179 (10.1) | 49 (8.9) | 5 (3.4) | 9 (6.8) | 41 (12.6) | 8 (7.6) | 14 (14.0) | 27 (12.0) | 26 (14.3) | |
Other | 106 (5.9) | 33 (6.0) | 3 (2.1) | 4 (3.0) | 28 (8.6) | 3 (2.9) | 9 (9.0) | 18 (8.0) | 8 (4.3) | |
Posthoc analysis shows differences compared to the expected for: widowed: 0 (−), 1 (−), 2 (−), 3 (+), 4 (−), 5 (+), 6 (+), 7 (+)| Married: 0 (+), 1 (+), 2 (+), 3 (−), 4 (+), 5 (−), 6 (−), 7(−) | Divorced: 1 (−) | other 1 (−) | ||||||||||
Living situation**a | 12 (0.7) | |||||||||
Independent alone | 1151 (65.1) | 262 (47.6) | 56 (38.1) | 50 (37.9) | 309 (95.1) | 31 (29.0) | 93 (93.0) | 201 (89.3) | 149 (81.9) | |
Independent with others | 579 (32.7) | 280 (50.9) | 85 (57.8) | 79 (59.8) | 14 (4.3) | 76 (71.0) | 5 (5.0) | 19 (8.4) | 21 (11.5) | |
Independent living with possible assistance | 25 (1.4) | 5 (0.9) | 5 (3.4) | 1 (0.8) | 0 | 0 | 2 (2.0) | 3 (1.3) | 10 (5.5) | |
Posthoc analysis shows differences compared to the expected for: Independent alone: 0 (−), 1 (−), 2 (−), 3 (+), 4 (−), 5 (+), 6 (+), 7(+) | Independent with others: 0 (+), 1 (+), 2 (+), 3 (−), 4 (+), 5 (−), 6 (−), 7 (−) | ||||||||||
Income (Lower than €1200 net per month) | 598 (33.8) | 137 (7.7) | 160 (29.1) | 44 (29.9) | 40 (30.3) | 120 (36.9) | 43 (40.2) | 40 (40) | 76 (33.8) | 75 (41.2) |
Health perception** | 8 (0.5) | |||||||||
Excellent/very good | 219 (12.4) | 121 (22) | 2 (1.4) | 11 (15.6) | 62 (19) | 0 | 3 (3) | 19 (8.4) | 1 (0.5) | |
Good | 611 (34.6) | 247 (44.9) | 36 (24.5) | 57 (43.2) | 145 (44.6) | 11 (10.3) | 17 (17) | 81 (36) | 17 (9.3) | |
Reasonable/bad | 930 (52.6) | 178 (32.4) | 108 (73.5) | 64 (48.5) | 117 (36) | 95 (88.8) | 80 (80) | 124 (55.2) | 164 (90.1) | |
Posthoc analysis shows differences compared to the expected for: excellent very good: 0 (+), 1 (−), 3 (−), 4 (−), 5 (−), 7 (−) | good: 0 (+), 1 (−), 3 (+), 4 (−), 5 (−), 7 (−) | reasonable/bad: 0 (−), 1 (+), 3 (−), 4 (+), 5 (+), 7 (+) | ||||||||||
Number of conditions** (Range: 0–11) | 2.61 (1.85) | Unknown | 1.9 (1.4) | 3.6 (1.7) | 2.3 (1.5) | 1.9 (1.3) | 4.1 (1.8) | 3.6 (1.8) | 2.3 (1.6) | 4.5 (2.0) |
Posthoc analysis shows significant differences for: 0–1**, 0–4**, 0–5**, 0–6*, 0–7**, 1–2**, 1–3**, 1–6**, 1–7**, 2–4**, 2–5**, 2–7**, 3–4**, 3–5**, 3–6*, 3–7**, 4–6**, 5–6**, 5–7**, 6–7** | ||||||||||
ADL problems (Range: 0–15)** | 2.2 (2.5) | 51 (2.9) | 1.08 (1.7) | 4.0 (3.2) | 1.6 (2.0) | 1.3 (1.5) | 4.9 (3.3) | 3.5 (2.1) | 1.6 (1.7) | 4.1 (2.6) |
Posthoc analysis shows significant differences for: 0–1*, 0–4**, 0–5**, 0–7**, 1–2**, 1–3**, 1–4*, 1–6**, 2–4**, 2–5**, 2–7**, 3–4**, 3–5**, 3–7**, 4–5**,4–6**, 5–6**, 6–7** | ||||||||||
Help or assistance at home | ||||||||||
Home care** | 762 (43.1) | 23 (1.4) | 145 (26.4) | 82 (55.8) | 43 (32.6) | 129 (39.7) | 66 (61.7) | 71 (71.0) | 90 (40.0) | 136 (74.7) |
Posthoc analysis shows differences compared to the expected for: 0 (−), 1 (+), 4 (+), 5 (+), 7 (+) | ||||||||||
Informal care** | 360 (20.4) | 28 (2.9) | 74 (13.5) | 63 (42.9) | 25 (18.9) | 35 (10.8) | 49 (45.8) | 25 (25) | 22 (9.8) | 67 (36.8) |
Posthoc analysis shows differences compared to the expected for: 0 (−), 1 (+), 3 (−), 4 (+), 6 (−), 7 (+) |
Wellbeing | Total n = 1768 Respondents (%/SD) | Missing (%) | 0 n = 550 (31.1%) | 1 n = 147 (8.3%) | 2 n = 132 (7.5%) | 3 n = 325 (18.4%) | 4 n = 107 (6.1%) | 5 n = 100 (5.7%) | 6 n = 225 (12.7%) | 7 n = 182 (10.3%) |
---|---|---|---|---|---|---|---|---|---|---|
Quality of life | ||||||||||
Grade (SD)b | 7.3 (1.2) | 30 (1.7) | 7.9 (0.9) | 7.3 (1.1) | 7.2 (1.2) | 7.6 (1.0) | 6.5 (1.0) | 7.1 (0.9) | 6.8 (1.2) | 6.2 (1.2) |
Posthoc analysis shows significant differences for: 0–1b, 0–2b, 0–3b, 0–4b, 0–5b, 0–6b, 0–7b, 1–4b, 1–6b, 1–7b, 2–3a, 2–4b, 2–6a, 2–7b, 3–4b, 3–5b, 3–6b, 3–7b, 4–6a, 5–7b | ||||||||||
Compared to one year agob | 26 (1.5) | |||||||||
Much better | 71 (4.0) | 21 (3.8) | 6 (4.1) | 2 (1.5) | 26 (8.0) | 1 (0.9) | 5 (5.) | 7 (3.1) | 3 (1.6) | |
Little better | 127 (7.2) | 29 (5.3) | 8 (5.4) | 10 (7.6) | 25 (7.7) | 8 (7.5) | 5 (5) | 23 (10.2) | 19 (10.4) | |
the same | 1105 (62.5) | 430 (78.2) | 80 (54.4) | 81 (61.4) | 226 (69.5) | 42 (39.3) | 57 (57) | 134 (59.6) | 55 (30.2) | |
Little worse | 374 (21.2) | 60 (10.9) | 45 (30.6) | 35 (26.5) | 4 (13.5) | 40 (37.4) | 27 (27) | 45 (20.0) | 78 (42.9) | |
Much worse | 65 (3.7) | 2 (0.4) | 6 (4.1) | 3 (2.3) | 1 (0.3) | 14 (13.1) | 5 (5) | 8 (3.6) | 26 (14.3) | |
Posthoc analysis shows differences compared to the expected for: much better: 3 (+) | the same: 0 (+), 4 (−), 7(−) | little worse: 0 (−), 1 (+), 3 (−), 4 (+), 7 (+) | much worse: 0 (−), 3 (−), 4 (+), 7 (+) | ||||||||||
Lonelinessb Range: 0–11 | 3.9 (3.5) | 217 (12.3) | 1.7 (2.1) | 2.3 (2.6) | 3.1 (3.1) | 4.2 (3.2) | 4 (3.7) | 5.2 (3.2) | 6.9 (3.7) | 7.1 (3) |
Posthoc analysis shows significant differences for: 0–2b, 0–3b, 0–4b, 0–5b, 0–6b, 0–7b, 1–3b, 1–4b, 1–5b, 1–6b, 1–7b, 2–3a, 2–4b, 2–7b, 3–6b, 3–7b, 4–6b, 4–7b, 5–6b, 5–7b | ||||||||||
Going outsideb | 57 (3.3) | |||||||||
Daily | 917 (51.9) | 360 (65.5) | 49 (33.3) | 65 (49.2) | 181 (55.7) | 39 (36.4) | 35 (35) | 132 (58.7) | 56 (30.8) | |
Few times per week | 619 (35.0) | 128 (23.3) | 67 (45.6) | 55 (41.7) | 128 (39.4) | 45 (42.1) | 49 (49) | 71 (31.6) | 76 (41.8) | |
Few times per month | 113 (6.4) | 17 (3.1) | 21 (14.3) | 7 (5.3) | 8 (2.5) | 12 (11.2) | 8 (8) | 12 (5.3) | 28 (15.4) | |
Less than once a month | 62 (3.5) | 7 (1.3) | 9 (6.1) | 3 (2.3) | 1 (0.3) | 10 (9.3) | 7 (7) | 6 (2.7) | 19 (10.4) | |
Posthoc analysis shows differences compared to the expected for: daily: 0 (+), 1 (−), 4 (−), 5 (−), 7 (−) | few times per week: 0 (−), 1 (+), 5 (+) | few times per month: 0 (−), 1 (+), 3 (−), 7 (+) | less than once a month: 0 (−), 4 (+), 7 (+) | ||||||||||
How often do you meet … | ||||||||||
Children or grandchildrena | 228 (12.9) | |||||||||
Every week | 771 (43.6) | 256 (46.5) | 78 (53.1) | 53 (40.2) | 136 (41.8) | 54 (50.5) | 37 (37) | 84 (37.3) | 73 (40.1) | |
Once or twice per month | 399 (22.6) | 119 (13.5) | 31 (21) | 38 (18.8) | 72 (22.1) | 22 (20.6) | 28 (28) | 47 (20.9) | 45 (14.7) | |
Less/seldom | 161 (9.1) | 33 (4.2) | 12 (8.1) | 13 (9.8) | 32 (9.9) | 15 (14) | 10 (10) | 27 (12) | 19 (10.4) | |
Never | 57 (3.2) | 13 (2.4) | 5 (3.4) | 3 (2.3) | 10 (3.1) | 5 (4.7) | 4 (4) | 9 (4) | 8 (4.4) | |
Not applicable | 152 (8.6) | 42 (7.6) | 8 (5.4) | 7 (5.3) | 33 (10.2) | 8 (7.5) | 15 (15) | 29 (12.9) | 10 (5.5) | |
Posthoc analysis shows differences compared to the expected for: less/seldom: 0 (−) | not applicable: 6 (+) | ||||||||||
Family/in-lawsb | 314 (17.8) | |||||||||
Every week | 289 (16.3) | 109 (19.8) | 25 (17) | 13 (9.8) | 62 (19.1) | 20 (18.7) | 12 (12) | 29 (12.9) | 19 (10.4) | |
Once or twice per month | 371 (21.0) | 122 (22.2) | 39 (26.6) | 35 (26.5) | 58 (17.8) | 22 (20.5) | 19 (19) | 39 (17.3) | 37 (20.3) | |
Less/seldom | 410 (23.2) | 99 (18) | 35 (23.8) | 35 (27.1) | 72 (22.2) | 28 (26.2) | 30 (30) | 63 (28) | 48 (26.4) | |
Never | 177 (10.0) | 44 (8) | 10 (6.8) | 4 (3) | 31 (9.5) | 14 (13.1) | 17 (17) | 30 (13.3) | 27 (14.8) | |
Not applicable | 207 (11.7) | 63 (11.5) | 25 (17) | 17 (12.9) | 40 (12.3) | 13 (12.1) | 9 (9) | 21 (9.3) | 19 (10.4) | |
Posthoc analysis shows differences compared to the expected for: every week: 0 (+), 7 (−) | less /seldom: 0 (−) | never: 2 (−), 5 (+), 7 (+) | ||||||||||
Friendsb | 172 (9.7) | |||||||||
Every week | 728 (41.2) | 259 (47.1) | 67 (45.6) | 50 (37.9) | 143 (44) | 39 (36.4) | 33 (33) | 90 (40) | 47 (25.8) | |
Once or twice per month | 506 (28.6) | 147 (26.8) | 44 (30) | 42 (31.8) | 94 (28.9) | 33 (30.9) | 31 (31) | 62 (27.1) | 53 (29.1) | |
Less/seldom | 264 (15.0) | 59 (10.8) | 16 (10.9) | 21 (15.9) | 35 (10.7) | 27 (23.4) | 27 (27) | 38 (16.8) | 41 (22.5) | |
Never | 64 (3.6) | 7 (1.3) | 5 (3.4) | 3 (2.3) | 13 (4) | 3 (2.8) | 6 (6) | 8 (3.6) | 19 (10.4) | |
Not applicable | 34 (1.9) | (71.3) | 6 (4.1) | 2 (1.5) | 6 (1.8) | 3 (2.8) | 0 | 4 (1.8) | 6 (6.3) | |
Posthoc analysis shows differences compared to the expected for: every week: 0 (+), 7 (−) | less/seldom: 0 (−), 4 (+), 5 (+) | never: 0 (−), 7 (+) | ||||||||||
Neighboursb | 144 (8.1) | |||||||||
Every week | 1006 (56.9) | 375 (68.2) | 87 (59.2) | 74 (56.1) | 181 (55.7) | 51 (47.7) | 47 (47) | 116 (51.6) | 75 (41.2) | |
Once or twice per month | 298 (16.8) | 67 (12.2) | 27 (18.4) | 24 (18.1) | 67 (20.3) | 22 (20.6) | 20 (20) | 24 (15.1) | 38 (20.9) | |
Less/seldom | 218 (12.3) | 32 (5.6) | 17 (11.6) | 17 (12.9) | 37 (11.4) | 23 21.5) | 17 (17) | 43 (19.1) | 32 (17.6) | |
Never | 80 (4.5) | 8 (1.5) | 7 (4.8) | 2 (1.5) | 8 (2.5) | 8 (7.5) | 11 (11) | 14 (6.2) | 22 (12.1) | |
Not applicable | 22 (1.2) | 8 (1.5) | 2 (1.4) | 1 (0.8) | 5 (1.5) | 1 (0.9) | 2 (2) | 1 (0.4) | 2 (1.1) | |
Posthoc analysis shows differences compared to the expected for: every week: 0 (+), 7 (−) | once or twice per month: 0 (−) | less/seldom: 0 (−), 4 (+), 5 (+), 7 (+) | never: 0 (−), 5 (+), 7 (+) |