Background
Methods
Study population
Conceptual model of frailty
Operationalization of frailty domains
Domains | Criteria | Cut-off | Based on |
---|---|---|---|
Physical frailty | - Unintentional weight loss - Exhaustion - Low handgrip strength - Perceived health - Limited in walking - Disturbed balance - Hearing impairment - Vision impairment | ≥4 criteria | - Unintentional weight loss: >5% weight loss between round 4 and 5 and not being on a diet - Exhaustion: 2 questions of the Center for Epidemiologic Studies Depression scale (CES-D) [23] - Handgrip strength: dynamometer, sex-specific cut-off stratified for BMI [1] - Self-reported 100 m walking - Tandem Stand Balance Test - 3 questions regarding hearing - 3 questions regarding vision |
Cognitive frailty | - Low global cognitive functioning | <10th percentile | Global cognitive functioning score based on tests for memory, speed and flexibility [63]: 15 Words Verbal Learning Test Stroop Colour–Word Test Word Fluency Test Letter Digit Substitution Test |
Psychological frailty | - Depressive symptoms - Mental health | =2 criteria | - Center for Epidemiologic Studies Depression scale (CES-D) [23] |
Social frailty | - Loneliness - Low social support - Limited social participation | ≥2 criteria | - Social Support List-12 (SSL-12) [26] - Questionnaire Dutch Elderly Monitor [27] |
Other measurements
Socio-demographic factors
Lifestyle
Life events
Biological risk factors and chronic disease
Statistical analyses
Results
Study population (N = 4019) | Physically frail (N = 110; 2.7%) | Psychologically frail (N = 252; 6.3%) | Cognitively frail (N = 311; 7.7%) | Socially frail (N = 166; 4.1%) | |
---|---|---|---|---|---|
Socio-demographic | |||||
Women | 2118 (52.7%) | 70 (63.6%) | 173 (68.7%) | 97 (31.2%) | 81 (48.8%) |
Age, yr | 59.9 (SD 9.6) | 68.7 (SD 9.1) | 59.3 (SD 9.9) | 68.8 (SD 8.0) | 63.0 (SD 10.4) |
Level of education | |||||
Low | 1657 (41.2%) | 76 (69.1%) | 142 (56.3%) | 154 (49.5%) | 94 (56.6%) |
Intermediate | 1320 (32.9%) | 14 (12.7%) | 67 (26.6%) | 85 (27.3%) | 47 (28.3%) |
High | 1042 (25.9%) | 20 (18.2%) | 43 (17.1%) | 72 (23.2%) | 25 (15.1%) |
Married | 3211 (80.3%) | 63 (57.3%) | 151 (60.4%) | 232 (75.3%) | 108 (65.1%) |
Living alone | 555 (13.9%) | 38 (34.6%) | 63 (25.2%) | 68 (22.2%) | 43 (25.9%) |
Paid job | 2024 (50.5%) | 7 (6.4%) | 113 (44.8%) | 52 (16.8%) | 59 (35.8%) |
Lifestyle | |||||
Current smoking | 682 (17.1%) | 30 (27.8%) | 77 (30.7%) | 51 (16.6%) | 34 (20.7%) |
Healthy diet, score (0–7) | 2.9 (SD 1.2) | 2.6 (SD 1.1) | 2.9 (SD 1.1) | 2.8 (SD 1.2) | 2.9 (SD 1.2) |
Physically active | 3112 (77.5%) | 46 (41.8%) | 170 (67.5%) | 212 (68.4%) | 108 (65.1%) |
Sleep duration | |||||
≤5 h | 163 (4.1%) | 12 (11.0%) | 29 (11.5%) | 15 (4.9%) | 17 (10.3%) |
6 h | 703 (17.6%) | 24 (22.0%) | 71 (28.3%) | 52 (16.8%) | 36 (21.7%) |
7 or 8 h | 2880 (72.2%) | 56 (51.4%) | 127 (50.6%) | 208 (67.3%) | 95 (57.2%) |
≥9 h | 245 (6.1%) | 17 (15.6%) | 24 (9.6%) | 34 (11.0%) | 18 (10.8%) |
Alcohol consumption | |||||
Never | 399 (10.0%) | 28 (25.5%) | 40 (15.9%) | 39 (12.6%) | 21 (12.7%) |
Not anymore | 124 (3.1%) | 11 (10.0%) | 16 (6.3%) | 15 (4.8%) | 9 (5.5%) |
Low (<1 glass/wk) | 849 (21.2%) | 23 (20.9%) | 61 (24.2%) | 54 (17.4%) | 39 (23.6%) |
Frequent (≥1 glasses/wk) | 2630 (65.7%) | 48 (43.6%) | 135 (53.6%) | 202 (65.2%) | 96 (58.2%) |
Life events | |||||
Widowed | 74 (2.0%) | 4 (4.0%) | 12 (5.3%) | 7 (2.5%) | 4 (2.6%) |
Divorced | 66 (1.7%) | 1 (1.0%) | 10 (4.4%) | 0 (0.0%) | 7 (4.6%) |
Biological risk factors and chronic disease | |||||
BMI, kg/m2
| 26.8 (SD 4.2) | 30.0 (SD 6.9) | 27.4 (SD 5.0) | 28.1 (SD 4.4) | 27.1 (SD 4.7) |
Multimorbiditya
| 320 (8.0%) | 43 (39.1%) | 40 (15.9%) | 61 (19.6%) | 26 (15.7%) |
Frailty | |||||
Physically frail | 110 (2.7%) | - | 34 (13.5%) | 26 (8.4%) | 19 (11.5%) |
Psychologically frail | 252 (6.3%) | 34 (31.2%) | - | 31 (10.0%) | 52 (31.3%) |
Cognitively frail | 311 (7.7%) | 26 (23.6%) | 31 (12.3%) | - | 20 (12.0%) |
Socially frail | 166 (4.1%) | 19 (17.3%) | 52 (20.6%) | 20 (6.5%) | - |
Factors associated with physical, psychological, cognitive, and social frailty
Physically frail | Psychologically frail | Cognitively frail | Socially frail | |||||
---|---|---|---|---|---|---|---|---|
Variables | Model 1d OR (95% CI) | Model 2e OR (95% CI) | Model 1 OR (95% CI) | Model 2 OR (95% CI) | Model 1 OR (95% CI) | Model 2 OR (95% CI) | Model 1 OR (95% CI) | Model 2 OR (95% CI) |
Socio-demographic | ||||||||
Women | 1.10 (0.71 1.68) |
1.67 (1.26 2.21)
|
1.90 (1.37 2.63)
|
0.29 (0.22 0.39)
|
0.26 (0.19 0.36)
|
0.69 (0.49 0.95)
|
0.59 (0.41 0.85)
| |
Age | ||||||||
40–49 yra
| 1 | 1 | 1 | - | - | 1 | ||
50–59 yra
| 1.61 (0.53 4.92) | 1.93 (0.53 7.04) | 1.02 (0.70 1.49) | 1 | 1 | 1.10 (0.65 1.86) | ||
60–69 yr | 1.23 (0.40 3.76) | 1.79 (0.48 6.62) | 0.70 (0.44 1.10) | 1.35 (0.89 2.06) | 1.28 (0.82 2.00) | 0.97 (0.53 1.78) | ||
70–81 yr |
3.00 (1.00 9.07)
|
3.89 (1.05 14.42)
|
0.50 (0.29 0.86)
|
3.91 (2.50 6.12)
|
3.32 (2.06 5.35)
| 1.46 (0.76 2.80) | ||
Level of education | ||||||||
Low | 1.58 (0.94 2.66) | 0.88 (0.49 1.57) |
1.88 (1.31 2.71)
|
1.52 (1.03 2.24)
|
1.49 (1.08 2.06)
|
2.24 (1.42 3.54)
|
2.06 (1.27 3.34)
| |
Intermediate | 0.60 (0.30 1.22) |
0.42 (0.21 0.95)
| 1.20 (0.80 1.78) | 0.93 (0.60 1.43) | 1.15 (0.81 1.64) | 1.56 (0.95 2.56) | 1.31 (0.77 2.23) | |
High | 1 | 1 | 1 | 1 | 1 | 1 | 1 | |
Married |
0.36 (0.18 0.72)
|
0.30 (0.21 0.45)
|
0.34 (0.22 0.55)
| 0.74 (0.42 1.31) |
0.48 (0.28 0.82)
|
0.47 (0.26 0.87)
| ||
Living alone | 0.80 (0.38 1.70) | 0.82 (0.52 1.30) | 1.13 (0.62 2.07) | 1.04 (0.57 1.91) | ||||
Paid job |
0.11 (0.04 0.26)
|
0.16 (0.07 0.41)
|
0.69 (0.49 0.98)
|
0.42 (0.28 0.64)
|
0.36 (0.23 0.56)
| 0.66 (0.42 1.04) | ||
Lifestyle | ||||||||
Current smoking |
2.55 (1.60 4.07)
|
3.18 (1.87 5.42)
|
1.93 (1.43 2.59)
|
1.92 (1.37 2.67)
| 1.53 (1.08 2.17) | 1.25 (0.84 1.86) | ||
Healthy diet |
0.79 (0.67 0.94)
|
0.78 (0.64 0.94)
| 1.06 (0.95 1.18) |
0.87 (0.78 0.97)
|
0.88 (0.79 0.99)
| 1.00 (0.88 1.14) | ||
Physically active |
0.22 (0.14 0.32)
|
0.32 (0.20 0.51)
|
0.62 (0.47 0.82)
|
0.71 (0.52 0.98)
|
0.50 (0.38 0.66)
|
0.60 (0.40 0.82)
|
0.58 (0.42 0.82)
|
0.60 (0.41 0.86)
|
Sleep duration | ||||||||
≤ 5 h |
2.97 (1.51 5.84)
|
2.44 (1.10 5.43)
|
4.14 (2.62 6.55)
|
4.25 (2.58 6.98)
| 1.36 (0.75 2.46) |
2.89 (1.66 5.05)
|
3.11 (1.73 5.60)
| |
6 h |
1.84 (1.11 3.05)
| 1.54 (0.86 2.75) |
2.36 (1.73 3.22)
|
2.39 (1.72 3.34)
| 1.20 (0.85 1.69) |
1.55 (1.04 2.31)
| 1.38 (0.89 2.14) | |
7 or 8 h | 1 | 1 | 1 | 1 | 1 | 1 | 1 | |
≥ 9 h |
2.36 (1.32 4.21)
| 1.66 (0.86 3.22) |
2.42 (1.50 3.91)
|
2.11 (1.24 3.59)
| 1.40 (0.90 2.15) |
1.93 (1.13 3.30)
| 1.71 (0.96 3.05) | |
Alcohol consumption | ||||||||
Never | 1 | 1 | 1 | 1 | 1 | |||
Not anymore | 1.38 (0.62 3.06) | 1.46 (0.59 3.60) | 1.61 (0.84 3.06) | 0.86 (0.43 1.73) | 1.14 (0.48 2.68) | |||
Low (<1 glass/wk) |
0.54 (0.30 0.97)
| 0.55 (0.27 1.12) | 0.70 (0.46 1.08) |
0.60 (0.37 0.96)
| 0.97 (0.56 1.70) | |||
Frequent (≥1 glasses/wk) |
0.40 (0.24 0.68)
|
0.53 (0.29 0.98)
|
0.65 (0.44 0.96)
|
0.60 (0.40 0.91)
| 0.78 (0.47 1.31) | |||
Life events | ||||||||
Widowed | 0.51 (0.17 1.54) | 1.48 (0.74 2.97) | 0.60 (0.25 1.42) | 0.51 (0.17 1.48) | ||||
Divorcedb
| 0.76 (0.10 5.95) | 1.30 (0.62 2.74) | - | 2.15 (0.89 5.17) | ||||
Biological risk factors and chronic disease | ||||||||
BMI | ||||||||
Normal (<25 kg/m2) | 1 | 1 | 1 | 1 | ||||
Overweight (25–30 kg/m2) | 0.67 (0.39 1.14) | 1.25 (0.92 1.71) | 1.29 (0.94 1.76) | 0.78 (0.54 1.12) | ||||
Obese (≥30 kg/m2) |
2.12 (1.29 3.47)
| 1.24 (0.86 1.80) |
1.80 (1.26 2.59)
| 0.72 (0.46 1.14) | ||||
Multimorbidityc
|
4.47 (2.95 6.79)
|
3.81 (2.32 6.26)
|
2.22 (1.55 3.18)
|
1.83 (1.16 2.87)
|
1.71 (1.25 2.34)
| 1.30 (0.84 2.02) |