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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: mandrew@dal.ca.
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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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