The impact of biological frailty syndrome on quality of life of nursing home residents

Abstract

Increased longevity is a social success that also implicitly entails enormous challenges: adding years to life often implies the management of more geriatric syndromes and higher mortality and disability rates. Although disease and disability are not inevitable consequences of human ageing, the risk of being affected by them considerably increases with age (Baltes & Smith, 2003). The concept of frailty is becoming increasingly relevant in the field of geriatric care, although its precise definition remains disputed (Clegg, Young, Iliffe, Rikkert, & Rockwood, 2013). Ageing is associated with a functional decline; however, its morbidity varies: the decline is faster and leads to increased morbidity and mortality in some individuals, yet others remain robust despite their advanced age. Clinicians and researchers use the notion of frailty to help them understand the heterogeneous nature of human ageing (Zaslavsky, Thompson, & Demiris, 2012) and the literature describes three main theoretical models to explain it. Rockwood and Mitnitski (2011) consider it to be a variable state of health resulting from the accumulation of deficits, Fried et al. (2001) understand it as an interrelated biological syndrome but differentiate it from disease and disability, and Gobbens, Van Assen, Luijkx, and Schols (2012) take a comprehensive view of frailty. The proposal by Fried et al. (2001) has received a broad consensus, is widely used in clinics and in research (Morley et al., 2013; Santos-Eggimann, Cuénoud, Spagnoli, & Junod, 2009), and represents considerable progress in the understanding and exploration the pathophysiology of frailty. They define frailty as a biological syndrome characterized by a decline in reserves and resistance to stressors resulting from an accumulation of deficits in multiple physiological systems, which causes vulnerability and adverse effects on health. The five frailty criteria that they proposed, the "frailty phenotype" (unintentional weight loss, muscular weakness, low energy, slow ambulation speed, and low physical activity) were extensively tested in the Cardiovascular Health Study (CHS). Those with none of the above components were considered as robust, whereas those with one or two components were considered as pre-frail and those with more than two components as frail. The CHS results showed that there was a greater tendency toward frailty in women, as well as an association between frailty and poorer health results: mortality, disability, and hospitalization. Numerous studies later used the same criteria and produced similar results (

Social factors and quality of life aspects on frailty syndrome in community-dwelling older adults: the VERISAÚDE study

“…Taking into account the QoL, the consequences of being frail may substantially differ between being men and women, however, the literature on this topic is scarce. In a study, using the SF-12 [ 38 ] being frail was associated, among other variables, with health-related quality of life scores, both in men and in women [ 39 ].…”

Associations Between Nutritional Status, Frailty and Health-Related Quality of Life Among Older Long-Term Care Residents in Helsinki

“…However, Buckinx et al's study did not include residents with cognitive impairments. In their study, Serrano et al found the physical and mental components score of SF-12 to be significantly poorer among frail residents than among robust residents (20).…”

“…It is not surprising that the prefrail and frail residents differed in respect to their functioning, nutritional status and BMI. Previous studies have associated both nutritional status and higher dependency in ADL functions with frailty (8,10), and frailty with lower HRQoL (18)(19)(20). In Buckinx et al's study of older nursing home residents, all HRQoL dimensions were significantly poorer among the frail residents, except bodily pain (18).…”

“…Frailty has no simple definition, and its prevalence varies depending on the method used to evaluate it (17). Although it has been associated with reduced HRQoL in institutional settings (18)(19)(20), less is known about which factors modify the association between frailty and HRQoL. It is important to identify these factors and develop ways to promote residents' HRQoL in nursing homes.…”

The prevalence of frailty and its associated factors in an Italian institutionalized older population: findings from the cross-sectional Alvise Cornaro Center Study

“…[26,27]. Only a few studies have analysed the association between QoL and frailty in nursing homes: two out of three of these found an association [24,28] while the third did not [29].…”