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Psychological well-being in relation to frailty: a frailty identity crisis?

Published online by Cambridge University Press:  21 March 2012

Melissa K. Andrew ,
John D. Fisk  and
Kenneth Rockwood
Melissa K. Andrew*
Affiliation:
Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
John D. Fisk
Affiliation:
Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
Kenneth Rockwood
Affiliation:
Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
*
Correspondence should be addressed to: Dr. Melissa K. Andrew, Division of Geriatric Medicine, Department of Medicine, Dalhousie University, 5955 Veterans' Memorial Lane, Halifax, Nova Scotia B3H 2E1, Canada. Phone: +(902) 473-2378; Fax: +(902) 473-1050. Email: [email protected].
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Abstract

Background: Frailty can be defined as the presence of multiple, interacting medical and functional problems. Frailty is associated with psychiatric conditions but its relation to psychological well-being is unclear. A “frailty identity crisis” has been proposed as a maladaptive response to the sense of self as health deficits accumulate. We evaluated this so-called identity crisis by investigating associations between well-being, frailty, and mortality in community-dwelling older Canadians.

Methods: In this secondary analysis of the Canadian Study of Health and Aging (N = 5,703; age 70+), frailty was defined by an index of 33 health deficits. Psychological well-being was measured using Ryff's 18-item scale, with six domains (autonomy, personal growth, environmental mastery, positive relations, purpose in life, and self-acceptance). Cognition was measured using the Modified Mini-Mental State Examination. Associations between well-being, frailty, and mortality were measured using linear regression, adjusting for age, sex, education, cognition, and mental health.

Results: For each additional frailty-defining deficit, the psychological well-being score worsened by 0.3 points (0.29, 95% CI: 0.22–0.36, p < 0.001), independent of age, sex, education, cognition, and mental health. Among the six domains of well-being, only “purpose in life” and “autonomy” were not associated with frailty (all others, p < 0.001). Worse psychological well-being was associated with five-year mortality independent of age, sex, education, frailty, and mental health; this association was not statistically significant when adjusting for baseline cognition.

Conclusions: Frailty was associated with low levels of well-being. Psychological well-being impaired by a frailty identity crisis may play an important role in defining subjective health in older adults.

Keywords

frailtypsychological well-beingolder adultsmortalityhealth status
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Special Issue 8: Focus on late life depression , August 2012 , pp. 1347 - 1353
Copyright
Copyright © International Psychogeriatric Association 2012

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References

Abellan van Kan, G., Rolland, Y., Houles, M., Gillette-Guyonnet, S., Soto, M. and Vellas, B. (2010). The assessment of frailty in older adults. Clinics in Geriatric Medicine, 26, 275–286.CrossRefGoogle ScholarPubMed
Andrew, M. K. and Rockwood, K. (2007). Psychiatric illness in relation to frailty in community-dwelling elderly people without dementia: a report from the Canadian study of health and aging. Canadian Journal on Aging, 26, 33–38.CrossRefGoogle ScholarPubMed
Andrew, M. K., Mitnitski, A. and Rockwood, K. (2008). Social vulnerability, frailty, and mortality in elderly people. PLoS One, 3, e2232.CrossRefGoogle ScholarPubMed
Clarke, P. J., Marshall, V. W., Ryff, C. D. and Wheaton, B. (2001). Measuring psychological well-being in the Canadian Study of Health and Aging. International Psychogeriatrics, 13 (Supp. 1), 79–90.CrossRefGoogle ScholarPubMed
Erikson, E. H. and Erikson, J. M. (1997). The Life Cycle Completed. New York: W. W. Norton.Google Scholar
Fillit, H. and Butler, R. N. (2009). The frailty identity crisis. Journal of the American Geriatrics Society, 57, 348–352.CrossRefGoogle ScholarPubMed
Friedman, E. M., Hayney, M., Love, G. D., Singer, B. H. and Ryff, C. D. (2007). Plasma interleukin-6 and soluble IL-6 receptors are associated with psychological well-being in aging women. Health Psychology, 26, 305–313.CrossRefGoogle ScholarPubMed
Goggins, W. B., Woo, J., Sham, A. and Ho, S. C. (2005). Frailty index as a measure of biological age in a Chinese population. Journal of Gerontology: Medical Sciences, 60, 1046–1051.Google Scholar
Hogan, D. B., MacKnight, C. and Bergman, H. (2003). Models, definitions, and criteria of frailty. Aging: Clinical and Experimental Research, 15, 1–29.Google ScholarPubMed
Hubbard, R. E. and Woodhouse, K. W. (2010). Frailty, inflammation and the elderly. Biogerontology, 11, 635–641.Google Scholar
Kelly, M. J., Dunstan, F. D., Lloyd, K. and Fone, D. L. (2008). Evaluating cutpoints for the MHI-5 and MCS using the GHQ-12: a comparison of five different methods. BMC Psychiatry, 8, 10.Google Scholar
Kulminski, A. M., Ukraintseva, S. V., Kulminskaya, I. V., Arbeev, K. G., Land, K. and Yashin, A. I. (2008). Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: lessons from the Cardiovascular Health Study. Journal of the American Geriatrics Society, 56, 898–903.CrossRefGoogle ScholarPubMed
Mitnitski, A. B., Song, X. and Rockwood, K. (2004). The estimation of relative fitness and frailty in community-dwelling older adults using self-report data. Journal of Gerontology: Medical Sciences, 59, M627–M632.Google Scholar
Mitnitski, A. et al. (2005). Relative fitness and frailty of elderly men and women in developed countries, in relation to mortality. Journal of the American Geriatrics Society, 53, 2184–2189.CrossRefGoogle ScholarPubMed
Rockwood, K., McDowell, I. and Wolfson, C. (2001). Canadian Study of Health and Aging. International Psychogeriatrics, 13 (Suppl. 1), 1–237.Google Scholar
Rockwood, K., Andrew, M. and Mitnitski, A. (2007). A comparison of two approaches to measuring frailty in elderly people. Journal of Gerontology: Medical Sciences, 62, 738–743.Google Scholar
Rockwood, K., Song, X. and Mitnitski, A. (2011). Changes in relative fitness and frailty across the adult lifespan: evidence from the Canadian National Population Health Survey. Canadian Medical Association Journal, 183, E487–E494.CrossRefGoogle ScholarPubMed
Ryff, C. D. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57, 1069–1081.Google Scholar
Teng, E. L. and Chui, H. C. (1987). The Modified Mini-Mental State (3MS) Examination. Journal of Clinical Psychiatry, 48, 314–318.Google ScholarPubMed
Ware, J. E. (1993). SF-36 Health Survey: Manual and Interpretation Guide. Boston, MA: The Health Institute.Google Scholar
Woo, J., Goggins, W., Sham, A. and Ho, S. C. (2006). Public health significance of the frailty index. Disability and Rehabilitation, 28, 515–521.Google Scholar