It is recognised that the focus of health-care interventions for frail older persons should not be restricted to increasing longevity, but should encompass measures aimed at improving or maintaining the health-related quality of life (HRQoL) of these individuals. We studied the HRQoL profile of 612 frail older persons residing in nursing homes and hostels in northern Sydney, Australia, and sought to ascertain some of the factors that affect their perceived quality of life. Our findings suggest that common health states that may cause loss of independence and dignity (e.g. presence of osteoarthritis, presence of urinary incontinence, previous fracture, Parkinson's Disease and increasing frailty as reflected by residence in nursing homes) are strongly, and independently, associated with the HRQoL of institutionalised older persons. Some of these conditions may be amenable to intervention.

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Very frail older people constitute an increasing proportion of aging populations and are likely to contribute substantially to costs due to osteoporosis. Quantitative ultrasound (QUS) of the calcaneus is potentially a simple method for assessing fracture risk in frail elderly, but there have been few studies of male/female differences in QUS or its relationship to falls risk or vitamin D status, which is often subnormal in this population. We studied QUS, falls risk and serum 25(OH)-vitamin D in subjects living in institutional aged care facilities (hostels or nursing homes). The study sample comprised 294 men (mean age 81.2 years, range 65-102 years) and 899 women (mean age 86.7 years, range 65-104 years). Broadband ultrasound attenuation (BUA) and velocity of sound (VOS) were higher in men than women by approximately 30% and 2% respectively ( p<0.0001) and this difference was maintained at all ages. Serum 25(OH)D levels were higher in men than women ( p<0.001) but vitamin D deficiency was very common in both sexes and serum 25(OH)D was not associated with QUS in either sex. There was no significant decline in BUA or VOS with age in men; however, for women BUA declined by 2.8-4.7% per decade and VOS by 1% per decade (both p<0.001). Mean BUA T-scores were -1.55 and -2.48 at age 90 years in men and women. Quadriceps strength and weight but not serum 25(OH)D were significantly associated with BUA. These data suggest only minor loss occurs at the calcaneal site in BUA and VOS with very old age in either sex.