Dimensions and correlates of quality of life according to frailty status: a cross-sectional study on community-dwelling older adults referred to an outpatient geriatric service in Italy. Health Qual Life Out 8:56

Department of Internal Medicine, Geriatric Medicine Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
Health and Quality of Life Outcomes (Impact Factor: 2.12). 06/2010; 8(1):56. DOI: 10.1186/1477-7525-8-56
Source: PubMed


There is a lack of knowledge concerning the relationship between two closely-linked multidimensional variables: frailty and quality of life (QOL). The aim of this study was to investigate dimensions and correlates of QOL associated with frailty status among community-dwelling older outpatients.
We conducted a cross-sectional survey of 239 community-dwelling outpatients aged 65+ (mean age 81.5 years) consecutively referred to a geriatric medicine clinic in Italy between June and November 2009. Participants underwent a comprehensive geriatric assessment, including assessment of their frailty status according to the Study of Osteoporotic Fractures (SOF) criteria, and QOL, which was evaluated by using the Older People's QOL (OPQOL) questionnaire. One-way ANOVA and chi-squared tests were used to find correlates of frailty, including QOL dimensions, after stratification of participants in the "robust" (n = 72), "pre-frail" (n = 89) and "frail" (n = 78) groups. Multiple linear regression analyses were performed to find correlates of QOL in the overall sample and among "frail" and "robust" participants.
A negative trend of QOL with frailty status was found for almost all dimensions of QOL (health, independence, home and neighbourhood, psychological and emotional well-being, and leisure, activities and religion) except for social relationships and participation and financial circumstances. Independent correlates of a poor QOL in the total sample were "reduced energy level" (SOF criterion for frailty), depressive status, dependence in transferring and bathing abilities and money management (adjusted R squared 0.39); among "frail" participants the associations were with depressive status and younger age, and among "robust" participants the association was with lower body mass index.
Five out of seven dimensions of QOL were negatively affected by frailty, but only one SOF criterion for frailty was independently related to QOL, after correction for age, functional status and depression. A more advanced age as well as a better affective status were correlates of a better QOL among frail elders. Interventions targeting the QOL in frail community-dwelling older outpatients should consider as outcomes, not only health-related QOL, but also other domains of the QOL.

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Available from: Claudio Bilotta, Jan 08, 2014
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    • "Whereas, Chang et al. (2012) identified slowness as the major contributing component in the physical scale of SF-36, and poor endurance and energy in the mental scale of QOL. Using the Study of the Osteoporotic Fractures (SOF) criteria for frailty evaluation, the study by Bilotta et al. (2010) reported " reduced energy level " as the first predictor of QOL. Thus, little is known on the impact of single components of frailty on mental and physical domains of HRQOL. "
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    ABSTRACT: The aims of this study were to investigate the relationship between individual characteristics and Health Related Quality of Life (HRQOL), and to identify which components of physical frailty measured according to Fried's criteria provided a better explanation of HRQOL. Two hundred and fifty-nine older adults (age 74 ± 6 years; 69% were women) living in Piemonte Region were enrolled in this cross-sectional study. Socio-demographic and medical characteristics were captured by self-reported questionnaires. Physical frailty was assessed using the five criteria of Fried: shrinking, weakness, poor endurance and energy, slowness, and low physical activity level. HRQOL was measured with the 36-item Short-Form Health Survey (SF-36), using both the mental (MCS) and the physical component summary (PCS). Among individual characteristics, gender was the best predictor for SF-36, the MCS, and the PCS, with values of R2 of 12.7%, 12.1%, and 8.8%, respectively. Among the five Fried's criteria, poor endurance and energy had the largest effect on HRQOL with values of ΔR2 of 13.9% for SF-36, 13.4% for the MCS, and 9.4% for the PCS. Results highlighted the role of the individual characteristics and the single weight of the five components of physical frailty on HRQOL. This knowledge may give new insights about the relations between individual functioning and self-rated health, allowing the development of individualized and more effective preventive interventions for a healthy aging.
    Archives of Gerontology and Geriatrics 08/2014; 59(3). DOI:10.1016/j.archger.2014.08.012 · 1.85 Impact Factor
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    • "). However, divergent from other Western- European countries, Italy possesses a large population of those 65 years of age and older who are frail, yet, wanting to age in place (Bilotta et al. 2010; Cuénoud et al. 2009). This increase in the elder population has affected several aspects of Italian society both challenging the resilience of elders as they face new challenges of aging in place. "
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    ABSTRACT: Elders’ experiences while aging in place were obtained as part of an effort to develop a typology of emic (culture-specific) and etic (universal) models of aging. Data came from interviews with older adults in Italy, Thailand, Botswana, and the United States. Analysis of variance was used to examine similarities and differences in the samples. Comparing country data from the four collection sites, similarities were indicated for participants’ marital status, and having children and grandchildren. Differences were evident for the number of children and grandchildren, level of reported health and happiness, overall satisfaction with life, type of pension received, whether benefits are sufficient, the availability of extra revenue, and the number of daily and weekly activities indicated. Findings highlight the diverse cross-national aging experience of elders in this study. As worldwide demographic change leads to older populations and there are shifts in societal norms (in family involvement in caregiving, health care, and policy development), there is a dire need to understand how these changes impact elders at emic (culture/country-specific) and etic (universal) levels.
    Ageing International 03/2014; 39(4):348-368. DOI:10.1007/s12126-014-9198-7
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    • "A key study finding was in relation to base-line AQoL scores predicting one-year hospital readmission. This finding is consistent with Bilotta and colleagues’ study which found older adults’ assessment of overall HRQoL was independently predictive of emergency department readmissions [35]. To confirm the robustness of this association and to demonstrate that this finding is generalizable to a wider spectrum of patients admitted to acute care, this finding needs to be validated in a larger prospective cohort study of patients being discharged from acute care. "
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    ABSTRACT: Australia's ageing population means that there is increasing emphasis on developing innovative models of health care delivery for older adults. The assessment of the most appropriate mix of services and measurement of their impact on patient outcomes is challenging. The aim of this evaluation was to describe the health related quality of life (HRQoL) of older adults with complex needs and to explore the relationship between HRQoL, readmission to acute care and survival. The study was conducted in metropolitan Melbourne, Australia; participants were recruited from a cohort of older adults enrolled in a multidisciplinary case management service. HRQoL was measured at enrolment into the case-management service using The Assessment of Quality of Life (AQoL) instrument. In 2007--2009, participating service clinicians approached their patients and asked for consent to study participation. Administrative databases were used to obtain data on comorbidities (Charlson Comorbidity Index) at enrolment, and follow-up data on acute care readmissions over 12 months and five year mortality. HRQoL was compared to aged-matched norms using Welch's approximate t-tests. Univariate and multivariate logistic regression models were used to explore which patient factors were predictive of readmissions and mortality. There were 210 study participants, mean age 78 years, 67% were female. Participants reported significantly worse HRQoL than age-matched population norms with a mean AQOL of 0.30 (SD 0.27). Seventy-eight (38%) participants were readmitted over 12-months and 5-year mortality was 65 (31%). Multivariate regression found that an AQOL utility score <0.37 (OR 1.95, 95%CI, 1.03 -- 3.70), and a Charlson Comorbidity Index >=6 (OR 4.89, 95%CI 2.37 -- 10.09) were predictive of readmission. Multivariate analysis demonstrated that age >=80 years (OR 7.15, 95%CI, 1.83 -- 28.02), and Charlson Comorbidity Index >=6 (OR 6.00, 95%CI, 2.82 -- 12.79) were predictive of death. This study confirms that the AQoL instrument is a robust measure of HRQoL in older community-dwelling adults with chronic illness. Lower self-reported HRQoL was associated with an increased risk of readmission independently of comorbidity and kind of service provided, but was not an independent predictor of five-year mortality.
    Health and Quality of Life Outcomes 08/2013; 11(1):136. DOI:10.1186/1477-7525-11-136 · 2.12 Impact Factor
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