UNIVERSA MEDICINA

September-December, 2015 Vol.34 - No.3

Frailty decreases physical health domain of quality

of life in nursing home elderly

Yvonne Suzy Handajani*, Nelly Tina Widjaja*, and Yuda Turana**

ABSTRACT

BACKGROUND
Approximately 10-27% of the population aged >65 years suffers from *Department of Public Health,
frailty. The percentage increases with age so that the prevalence of frailty Faculty of Medicine and Center for
in the population aged >85 years reaches 45%. The objective of this study Health Research, Atma Jaya Catholic
University of Indonesia, Jakarta
was to determine the relationship between frailty and quality of life
**Department of Neurology,
(QOL) in nursing home elderly. Faculty of Medicine and Center for
Health Research, Atma Jaya Catholic
METHODS University of Indonesia, Jakarta
This was a cross-sectional study of 138 subjects aged >60 years who
were recruited from 4 nursing homes in West Jakarta. Participants with Correspondence
frailty status were evaluated by the Survey of Health, Ageing and Prof DR. drg. Yvonne Suzy Handajani,
Retirement in Europe (SHARE) instrument and QOL was evaluated by MKM
the WHOQOL-BREF questionnaire. One-way ANOVA and chi-square Department of Public Health,
Atma Jaya Catholic University of
tests were used to find relations between the frailty syndrome and QOL.
Indonesia, Jakarta
Jl. Pluit Raya No.2, Jakarta Utara
RESULTS 14440
The percentages of respondents with pre-frail, frail, and non-frail status Mobile: +62816 135 3738
were 30.4%, 52.2%, and 17.4%, respectively. A decline in QOL scores of Email: yvonne.sh@gmail.com
pre-frail and frail respondents was found for almost all QOL domains
(physical, psychological and environment domains), except social Univ Med 2015;34:213-9
relationships. The subdomains most influenced were “energy and fatigue” DOI: 10.18051/UnivMed.2016.v35.213-219
pISSN: 1907-3062 / eISSN: 2407-2230
in the physical health domain, “thinking, learning, memory and
concentration” in psychological health, and “opportunities for acquiring This open access article is distributed under
new information and skills” in the environment domain. a Creative Commons Attribution-Non
Commercial-Share Alike 4.0 International
License
CONCLUSIONS
More than half of the nursing home elderly were frail and one-third were
pre-frail. The main factor of frailty was weakness. The frailty syndrome
in the elderly has a negative impact on QOL, especially in the physical
health, psychological and environment domains in nursing home elderly.

Keywords: Frailty syndrome, quality of life, elderly, nursing homes

DOI: http://dx.doi.org/10.18051/UnivMed.2015.v34.213-219 213

Handajani, Widjaja, Turana Frailty decreases physical health

Frailty menurunkan kualitas hidup pada domain kesehatan fisik

pada lanjut-usia di panti werdha

ABSTRAK
LATAR BELAKANG
Sekitar 10-27% populasi lanjut usia (lansia) berusia >65 tahun menderita frailty. Presentasenya meningkat dengan
bertambahnya usia sehingga prevalensi frailty pada populasi berusia >85 tahun mencapai 45%. Tujuan dari
penelitian ini adalah untuk menentukan hubungan antara frailty kualitas hidup pada lansia di panti werdha.

METODE
Penelitian ini merupakan studi cross-sectional pada 138 subyek dengan usia >60 tahun yang didapatkan dari 4
panti werdha di Jakarta Barat. Status frailty subyek diukur dengan Survey of Health, Ageing and Retirement in
Europe (SHARE) dan kualitas hidup dilakukan penilaian dengan kuesioner WHOQOL-BREF. Uji One Way Anova
dan uji Chi-square digunakan untuk mendapatkan hubungan antara sindrom frailty dan kualitas hidup.

HASIL
Persentase responden dengan status pre-frail (30,4%), frail (52,2%) dan normal (17,4%). Penurunan skor kualitas
hidup lansia dengan status frailty dan pre-frail ditemukan hampir di semua domain kualitas hidup (domain fisik,
psikologis dan lingkungan), kecuali domain hubungan sosial. Subdomain yang paling dipengaruhi adalah “energi
dan kelelahan” pada domain kesehatan fisik, “berpikir, belajar, memori dan konsentrasi” pada domain kesehatan
psikologis, serta “peluang untuk memperoleh informasi dan keterampilan baru” pada domain lingkungan.

KESIMPULAN
Lebih dari setengah lansia mengalami frailty dan sepertiga lansia dengan status pre-frail di panti werdha. Faktor utama
frailty adalah kelemahan. Sindrom frailty pada lansia berdampak negatif pada kualitas hidup, khususnya pada domain
kesehatan fisik, psikologis dan lingkungan pada lansia di panti werdha.

Kata kunci: Sindrom frailty, kualitas hidup, lansia, panti werdha

INTRODUCTION suffering from frailty. (2) Frailty is a

heterogeneous clinical syndrome that may
An aging population is a challenge that include several different medical conditions, such
affects both the developed and developing as cardiovascular disease, musculoskeletal
countries. The growth of the elderly population disorders (arthritis, osteoporosis and fractures),
needs resources and health services to take care gastrointestinal disease and cognitive disorders.(4)
of.(1) Lately, geriatricians and gerontologists have Muscular strength, physical performance,
been focusing their attention on frailty in the nutritional status and psychological status are
elderly, which is increasing significantly. the parameters that are useful to evaluate the
Approximately 10-27% of the population aged frailty status of elderly.(5)
>65 years is suffering from frailty (2) and the Several studies have found a significant
percentage increases with age, so that the relationship between frailty and quality of life
prevalence of frailty in the population aged >85 (QOL), with lower QOL scores in respondents
years reaches 45%.(3) Several studies in Europe with frailty.(6) Similar results were also found in
found that 61.8% of the elderly population were the Taiwanese elderly population.(7)

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There has been little research on the effect Quality of life measurement was performed
of frailty on the QOL of elderly residing in with WHOQOL-BREF consisting of 26
nursing homes. The objective of the present study questions and 4 domains: 1) physical health; 2)
was to determine the relationship between frailty psychological; 3) social relationships; 4)
and QOL in nursing home elderly. environment and also to assess overall quality
of life and satisfaction about health. This is a
METHODS valid and reliable instrument to measure QOL
in the elderly.(9,10)
Research design
The design of this study was cross sectional Statistical analysis
and the study was conducted between April 2014 The one-way Anova test was used to analyze
and December 2015 at four nursing homes in the relationship between QOL and frailty status.
West Jakarta. The chi square test was used to analyze the effect
of overall QOL, satisfaction about health and the
Research subjects characteristics of respondents on frailty status. A
The size of the sample was calculated based p-value lower or equal to 0.05 (<0.05) was
on the formula of the sample size to test a planned considered as statistically significant.
proportion at 95% confidence level to achieve a
5% margin of error for the study. From previous Ethical clearance
studies, the prevalence of frailty was known to The research had been approved by Ethical
be 24.74% in elderly <85 years old and 45% in Clearance Committee, Faculty of Medicine,
elderly >85 years old. From the results of these Atma Jaya Catholic University of Indonesia on
calculations, the minimum sample size was 132. 3 April 2014.
This study comprised 138 subjects aged 60-95
years and living in four nursing homes in West RESULTS
Jakarta (Panti Sasana Tresna Werdha Budi
Mulia Jelambar, Panti Usila Santa Anna, Panti Based on the characteristics, 51.4% of the
Sosial Tresna Budi Mulia 2, Panti Sosial Tresna respondents were female, 81.2% were >65 years
Werdha Usada Mulia 5). The subjects were old, 64.5% had elementary education or lower,
recruited through the head of each nursing home, and 55.8% were divorced or widowed. This study
according to the inclusion and exclusion criteria. found that the percentages of normal or non-frail,
All of them gave signed informed consent. pre-frail, and frail respondents were 17.4%,
30.4%, and 52.2%, respectively. Regarding
Measurements overall QOL and satisfaction about health, 16.6%
Frailty was measured by means of the of respondents had poor QOL, 47.1% had
Survey of Health, Ageing and Retirement in sufficient QOL, and 36.3% good QOL, while
Europe (SHARE) instrument. (8) The 28.3% was not satisfied, 28.3% moderately
computations were done using two SHARE-FI satisfied and 43.5% satisfied about their health.
calculators, one for males and one for females, The assessment of the five components of frailty
which assessed the following five factors: 1) resulted in 34.8% with exhaustion, 22.5% with
fatigue; 2) loss of appetite; 3) grip strength; 4) loss of appetite, 53.6% were weaker on the right
functional difficulties (walking 100 m and handgrip and 49.3% on the left handgrip, 56.5%
climbing stairs) and 5) physical activity. Based had difficulty in walking and climbing stairs, and
on these factors, frailty was categorized into 36.2% had never done physical activity (Table
three groups, i.e. normal, pre-frail and frail. 1).

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Handajani, Widjaja, Turana Frailty decreases physical health

Table 1. Demographic characteristics, frailty The pre-frail respondents had lower QOL
status, overall quality of life, and satisfaction scores for the psychological domain of 1.58
about health in elderly points, as compared to those who were normal
(p=0.024). This means that the pre-frail
respondents did not have better QOL for the
psychological domain as compared to those who
were normal. Respondents with pre-fail or frail
health status did not show a significant
relationship with QOL for the domain of social
relations (p=0.228). The respondents with frail
health status had QOL scores for the environment
domain of 2.79 points, lower than those in the
normal (non-frail) respondents (p=0.007). It can
be concluded that frail respondents have worse
QOL scores for the environment domain compared
to the normal (non-frail) respondents (Table 2).
Post-hoc analysis showed that in elderly who
were frail the physical health, environment and
psychological domain was significantly declined
compared to normal elderly (Table 3).
The chi square test for frailty on overall QOL
and satisfaction about health, resulted in
significant relationships (p=0.035; p=0.009). The
largest percentage of those with low scores for
QOL and satisfaction about health of 53.4% and
55.1%, respectively, was found in frail
respondents, followed by those who were pre-frail,
The results of the analysis between frailty with respective scores of 35.2% and 34.6% (Table
status and each of the QOL domains showed that 4).
respondents who were pre-frail had a QOL score
for physical health of 2.10 points, lower than DISCUSSION
the QOL score in normal (non-frail) respondents
(p=0.018). Similarly, respondents who were frail The respondents in this study comprised
had a QOL lower than that in normal respondents 138 elderly living in nursing homes in West
(p=0.018). From these results we can conclude Jakarta. They were mostly women aged >65 years,
that pre-frail and frail respondents had worse QOL had elementary education or lower, and most of
scores for the physical health domain than normal them were divorced or widowed. Frailty is a health
respondents. condition that deals with aging and dependence.

Table 2. Distribution of the means of four QOL domains and total quality of life
by frailty status in elderly

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Table 3. Post-hoc analysis of physical health, home dwelling with slight variations in daily
psychological and environment domain activities negatively affect the status of physical
with frailty status fitness, body composition, and quality of life. Self-
motivation, active lifestyle, regular and varied
programs seem to have a major role in the quality
of life of the elderly population.(13)
An advanced age was predicted relating to
sensory, motoric and cognitive changes that
potentially prevent the elderly to function
effectively.(14) In advanced age, the physiological
system will have abnormalities in structure and
function. Age-related physiological changes
influence many tissues, organ systems and
functions, and cumulatively can impact on
activities of daily living (ADL).(15)
The findings of Fried et al.(16) showed that
A reduction or delay in frailty status can improve frailty was associated with a significant reduction
the quality of life of elderly. In this research, the in QOL. The results of other studies are consistent
percentages of respondents with pre-frail, frail, with their findings. Other investigators discovered
and non-frail status were 30.4%, 52.2%, and that frail subjects had worse overall QOL than
17.4%, respectively. pre-frail and non-frail subjects.(17,18) Lin et al.
Research conducted in Taiwanese reported that elderly who did not experience
communities found that 9.9% elderly were frail, weakness (frailty) significantly had better health
44.5% pre-frail and 45.6% non-frail. A cross- compared to the elderly with pre-frail and frail
sectional study showed that about 7% of elderly conditions at all scales. Similarly, those with pre-
aged 65 years was suffering from frailty and the frail status had reportedly better QOL than those
number would have increased to over 45 % after with a frail condition. Similarly, frail elderly had
the age of 85 years.(11) Based on Fried’s criteria significantly worse health related quality of life
about frailty, there were 5.9% frail, 62.8% pre- (HRQOL) than non-frail elderly in the same
frail and 31.3% non-frail subjects among elderly population. (7) Other findings reported that
who received health services in Taiwan.(12) outpatient subjects at health centers in Taiwan
Based on the findings above, the number of with frail status had significantly lower QOL
elderly with frailty in this research was found to scores (on physical and mental health scale) as
be greater than that in other studies. This is compared to the non-frail subjects.(12) Bilotta et
because the respondents were living in nursing al.(19) discovered a negative relationship between
homes so that their daily activities were less than frailty status and QOL of older subjects, measured
those of elderly who are living in the community. using the Older People’s Quality of Life (OPQOL)
This statement is supported by Barthalos et al questionnaire. Nearly all QOL dimensions
(2012) who informed that lifestyle and nursing- correlated inversely with frailty, except for “social

Table 4. Frailty, overall quality of life and satisfaction about health in elderly

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Handajani, Widjaja, Turana Frailty decreases physical health

relations and participation” as well as “financial physical health, psychological, and environment
circumstances”. domains. The subdomain most influenced was
The findings of the present study indicate “energy and fatigue” in the physical health
that respondents suffering from pre-frail and frail domain, “thinking, learning, memory and
condition had lower QOL scores for the physical concentration” in the psychological health
health domain, from the normal (non-frail) domain, and “opportunities for acquiring new
respondents. Likewise, the psychological domain information and skills” in the environment
score was lower in pre-frail respondents. In the domain.
environment domain score was lower in frail
respondents, while in the domain of social CONFLICT OF INTEREST
relationships, the relationship was not statistically
significant. Fontecha et al.(20) stated that functional None declared.
judgment was the most important factor in
determinating frailty. Masel et al.(6) found that in ACKNOWLEDGMENT
Mexican communities pre-frail and frail
respondents were significantly associated with The authors would like to thank the Sasana
lower QOL scores on physical and mental health Tresna Werdha Budi Mulia Jelambar, Santa
domains than elderly who were not frail. Anna, Tresna Budi Mulia 2, and Tresna Werdha
The frailty syndrome is closely related to Usada Mulia nursing homes for the opportunity
HRQOL of the elderly community in Taiwan who to carry out this study.
are using the Taipei health services. For frailty
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