Research Article

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

Melissa K. Andrew^a1 c1, John D. Fisk^a2 and Kenneth Rockwood^a1

^a1 Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

^a2 Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada

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.

(Received October 03 2011)

(Revised October 30 2011)

(Revised January 31 2012)

(Accepted February 05 2012)

(Online publication March 21 2012)

Key words:

• frailty;
• psychological well-being;
• older adults;
• mortality;
• health status

Correspondence:

^c1 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.