The association between lifestyle and overall health,using the frailty index

ObjectiveTo evaluate the associations of four individual lifestyle factors with frailty.MethodsWe used cross-sectional data from 11,539 participants of the Rotterdam Study, a population-based cohort, running from 1990 till now. A frailty index was used with a range from 0 to 100 (higher values indicating increasing frailty). We examined physical activity, dietary quality, alcohol intake, and smoking and calculated a sum-score of these, with a range from 0 (lowest) to 8 (highest). The associations between each lifestyle factor and the lifestyle score with frailty were evaluated.ResultsEach lifestyle factor was independently associated with frailty. Participants with high physical activity levels had lower frailty scores than participants with low physical activity (β = −4.70,95%CI = −5.10,−4.30). High diet quality, compared to low diet quality was associated with less frailty (β=-0.88,95%CI = −1.35,−0.42). Low alcohol intake was associated more frailty (β = 0.84, 95%CI = 0.39, 1.29). Never-smokers or former smokers had on average 1.15 (95%CI = −1.60,−0.69) and 1.28 (95%CI = −1.78,−0.79) better frailty scores than smokers. A one-unit increment of the lifestyle score was associated with lower frailty (β = −0.62;95%CI = −0.84,−0.53).ConclusionsThe prevention of frailty can lead to lower health care costs and a higher quality of life among the growing group of elderly people. Our results emphasize that there is an urgent need for preventions that combine several lifestyle factors to improve healthy ageing.     

Association between endothelial dysfunction and frailty: the Toledo Study for Healthy Aging

Cardiovascular disease (CVD), both clinical and subclinical, has been proposed as one of the mechanisms underlying frailty. However, there is no evidence addressing the relationship between the earliest stage of CVD (endothelial dysfunction) and frailty. The goal of the study was to analyze the association between endothelial dysfunction, evaluated by asymmetric dimethylarginine (ADMA) levels, and frailty. We used data from the Toledo Study for Healthy Aging, a prospective Spanish cohort study. Biological samples were obtained and ADMA levels were determined using an enzyme immunoassay method. Logistic regression was used to estimate the odds ratio (OR) and 95 % confidence intervals of frailty associated with ADMA. Adjustments were made for age, gender, cardiovascular risk factors, and presence of atherosclerotic disease (assessed by ankle–brachial index; ABI). One thousand two hundred eighty-seven community-dwelling elderly were included. One hundred seven (8.3 %) were identified as frail, 542 (42.1 %) as pre-frail, and 638 (49.6 %) as non-frail. ADMA values were higher in frail subjects than in non-frail ones. In addition, an interaction between the presence of atherosclerotic disease and ADMA on the odds of frailty (p = 0.045) was detected. After adjustments for age, classical cardiovascular risk factors, and ABI, the risk of frailty was associated with increasing levels of ADMA in subjects without atherosclerotic disease [OR for 1 standard deviation increase in ADMA = 1.14 (1.01–1.28), p = 0.032] but not in those with atherosclerotic disease. In our study, endothelial dysfunction, assessed by ADMA levels, is associated with frailty. These findings provide additional support for a relevant role of vascular system since its earliest stage in frailty.     

Association between inflammatory-related disease burden and frailty: Results from the Women's Health and Aging Studies (WHAS) I and II

Frailty is associated with a pro-inflammatory state, which has been characterized by elevated levels of systemic inflammatory biomarkers, but has not been related to the number of co-existing chronic diseases associated with inflammation. We sought to determine the extent to which a higher number of inflammatory-related diseases is associated with frailty and to identify the most common disease patterns associated with being frail in older adults. We performed binomial regression analyses to assess whether a higher count of inflammatory-related diseases increases the probability of frailty using data from the WHAS I and II, companion cohorts composed of 70-79-year-old community-dwelling older women in Baltimore, Maryland (n = 620). An increase of one inflammatory-related disease was associated log-linearly with frailty (Prevalence Ratio (PR) = 2.28, 95% Confidence Interval (CI) = 1.81-2.87). After adjusting for age, race, education, and smoking status, the probability of frailty remained significant (PR = 1.97, 95%CI = 1.52-2.55). In the frail population, chronic kidney disease (CKD) and depressive symptoms (Prevalence = 22.9%, 95%CI = 14.2-34.8%); CVD and depressive symptoms (21.7%, 95%CI = 13.2-33.5%); CKD and anemia (18.7%, 95%CI = 11.1-29.7%); cardiovascular disease (CVD), CKD, and pulmonary disease (10.7%, 95%CI = 5.2-21.0%); CKD, anemia, and depressive symptoms (8.7%, 95%CI = 3.9-18.2%); and CVD, anemia, pulmonary disease, and depressive symptoms (5.0%, 95%CI = 1.6-14.4%) were among the most frequent disease combinations. Their prevalence percentages were significantly higher in the frail versus non-frail women. A higher inflammatory-related disease count, perhaps reflecting a greater pro-inflammatory burden, increases the likelihood of frailty. Shared mechanisms among specific disease combinations may further contribute to this risk.     

Frailty defined by deficit accumulation and geriatric medicine defined by frailty

As nonreplicative cells age, they commonly accumulate subcellular deficits that can compromise function. As people age, they too experience problems that can accumulate. As deficits (symptoms, signs, illnesses, disabilities) accumulate, people become more susceptible to adverse health outcomes, including worse health and even death. This state of increased risk of adverse health outcomes is indistinguishable from the idea of frailty, so deficit accumulation represents another way to define frailty. Counting deficits not only allows grades of frailty to be discerned but also provides insights into the complex problems of older adults. This process is potentially useful to geriatricians who need to be experts in managing complexity. A key to managing complexity is through instruments such as a comprehensive geriatric assessment, which can serve as the basis for routine clinical estimation of an individual's degree of frailty. Understanding people and their needs as deficits accumulate is an exciting challenge for clinical research on frailty and its management by geriatricians.     

Associations between multidimensional frailty and quality of life among Dutch older people

PurposeTo examine the associations between components of physical, psychological and social frailty with quality of life among older people.MethodsThis cross-sectional study was carried out in a sample of Dutch citizens. A total of 671 people aged 70 years or older completed a web-based questionnaire (‘the Senioren Barometer’). This questionnaire contained the Tilburg Frailty Indicator (TFI) for measuring physical, psychological and social frailty, and the WHOQOL-OLD for measuring six quality of life facets (sensory abilities, autonomy, past, present and future activities, social participation, death and dying, intimacy) and quality of life total.ResultsNine of fifteen individual frailty components had an effect on at least one facet of quality of life and quality of life total, after controlling for socio-demographic factors, multimorbidity and the other frailty components. Of these nine components five, two and two refer to physical, psychological and social frailty, respectively. Feeling down was the only frailty component associated with all quality of life facets and quality of life total. Both physical inactivity and lack of social relations were associated with four quality of life facets and quality of life total.ConclusionThis study showed that quality of life in older people is associated with physical, psychological and social frailty components, emphasizing the importance of a multidimensional assessment of frailty. Health care and welfare professionals should in particular pay attention to feeling down, physical inactivity and lack of social relations among older people, because their relation with quality of life seems to be the strongest.     

Daily electromyography in females with Parkinson's disease: A potential indicator of frailty

Females with Parkinson's disease (PD) are at increased risk for frailty, yet are often excluded from frailty studies. Daily electromyography (EMG) recordings of muscle activity can dissociate stages of frailty and indicate functional decline in non-neurological conditions. The purpose of this investigation was to determine whether muscle activity can be used to identify frailty phenotypes in females with PD. EMG during a typical 6.5-h day was examined in biceps brachii, triceps brachii, vastus lateralis and biceps femoris on less-affected PD side. Muscle activity was quantified through burst (>2% maximum exertion, >0.1 s) and gap characteristics (<1% maximum exertion, >0.1 s). Differences across frailty phenotype (nonfrail, prefrail, frail) and muscle (biceps brachii, BB; triceps brachii, TB; vastus lateralis, VL; biceps femoris, BF) were evaluated with a 2-way repeated measure ANOVA for each burst/gap characteristic. Thirteen right-handed females (mean = 67 ± 8 years) were classified as nonfrail (n = 4), prefrail (n = 6), and frail (n = 3) according to the Cardiovascular Health Study frailty index (CHSfi). Frail females had 73% decreased gaps and 48% increased burst duration compared with nonfrail. Decreased gaps may be interpreted as reduced muscle recovery time, which may result in earlier onset fatigue and eventually culminating in frailty. Longer burst durations suggest more muscle activity is required to initiate movement leading to slower movement time in frail females with PD. This is the first study to use EMG to dissociate frailty phenotypes in females with PD during routine daily activities and provides insight into how PD-associated motor declines contributes to frailty and functional decline.     

Untangling the overlap between frailty and low lean mass: Data from Toulouse frailty day hospital

BackgroundThe decline in lean mass, observed in older people, has been frequently associated with frailty. This assumption has scarcely been assessed. This study explored the association between current proposed definitions of low lean mass and the Fried phenotype of frailty.MethodsCross-sectional study. Participants admitted to the Toulouse frailty day hospital, with an assessment of body composition, 70 years or older were included consecutively in the study. Low lean mass (LLM), was identified using five international operative definitions. To construct the definitions, muscle mass was assessed using Intelligent Dual Energy X-ray absorptiometry (I-DXA, LUNAR). Frailty was assessed using the Fried criteria.ResultsData from 283 participants, mean age 82 years and 71% of women were analyzed. LLM was identified between 8.5% and 39.2% of the participants according to the different definitions. Frailty was identified in 46.6% of the sample. 9.1%–48.5% of the frail older people had LLM depending on the definition. The highest association between frailty and LLM was observed with the definition proposed by the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project [adjusted Odds Ratio 2.64; 95% confidence interval 1.5–4.8].ConclusionThe decline in lean mass is a component of the frailty syndrome but not universally present. Indeed, LLM and frailty were associated and partly overlapped. Future research including longitudinal studies should exploit the added value of combining LLM and frailty measures in preventing disability and other negative health outcomes.     

Glomerular filtration rate in the elderly and in the oldest old: correlation with frailty and mortality

The equations for estimating kidney function have become very popular in the last decade. However, the clinical and prognostic meaning of these measures may be very different in older populations. Two cohorts of people aged 65–89 years (older sample) and 90 or more (oldest old sample) were used to investigate the prognostic significance of estimated glomerular filtration rate (eGFR). Additionally, we also investigated whether combining frailty and eGFR may improve the accuracy of frailty in predicting mortality. We found that lower eGFR values were significantly more frequent among frail subjects in both groups. eGFR < 30 was associated with increased risk for all-cause mortality either in subjects aged 65–89 years (HR = 3.71, 95% CI = 1.23–11.2) or in those aged 90 or more (HR = 1.53, 95% CI = 1.05–2.23). In the latter group, a not significant trend for increasing mortality was also observed among people with eGFR > 60 (HR = 1.28, 95% CI = 0.72–2.26). In addition, the oldest old subjects with eGFR > 60 and eGFR < 30 had the lowest hand-grip strength and ADL values. Combining eGFR and frailty status significantly improved the accuracy of frailty in predicting mortality only in the older sample. In conclusion, a U-shaped relationship exists between eGFR and mortality in the oldest old, but not in older individuals. Our findings suggest that eGFR needs to be adjusted for muscle mass/physical performance when estimating kidney function in people aged 90 or more. Nevertheless, in subjects aged 65–89 years, eGFR may improve the accuracy of frailty status in predicting prognosis, thus suggesting that eGFR may represent an additional dimension of frailty syndrome.     

The relationship between atrial fibrillation and frailty in community-dwelling older adults

Objectives(1) To compare the frailty status between community-dwelling older adults with and without atrial fibrillation (AF) in Taiwan and (2) to test the hypothesis that AF is associated with frailty in community-dwelling older adults.MethodsWe conducted a cross-sectional study in several communities in Taipei. AF was confirmed by electrocardiogram recordings or medical diagnosis. Frailty status was assessed using both the Cardiovascular Health Study (CHS) frailty phenotype and Edmonton Frail Scale (EFS).ResultsA total of 207 community-dwelling older adults voluntarily participated in this study, and 38 had AF. There was a significantly higher percentage of frailer (prefrail and frailty) older adults in the AF group (69 % vs. 36 %, p < 0.001) according to CHS phenotype, but no significant difference was detected by EFS criteria (92 % vs. 92 %, p = 0.966). The AF group showed significantly lower grip strength in men (26.8 ± 8.3 vs. 33.0 ± 6.9 kg, p = 0.006), walking speed (1.1 ± 0.3 vs. 1.2 ± 0.3 m/s, p = 0.003), and Timed Up and Go performance (8.8 ± 2.4 vs. 7.0 ± 1.9 s, p < 0.001) than the control group. The multiple logistic regression model showed that AF was an independent factor associated with frailer community-dwelling older adults after adjusted for covariates (odds ratio, 3.02; 95 % confidence interval, 1.32–6.89, p = 0.009).ConclusionCommunity-dwelling older adults with AF showed a significantly higher percentage of frailer individuals and lower physical function than those without AF. Furthermore, AF was an independent predictor of frailer community-dwelling older adults.     

An index of Brazilian frailty and its association with social factors

BackgroundThe Brazilian population is aging rapidly and it is necessary to establish tools to map the elderly population regarding its frailty, which is a common adverse condition during the aging process. The National Health Survey (PNS in Portuguese) data makes it possible.ObjectiveThis study aimed to construct a frailty index (FI) of the elderly Brazilian population using the PNS data, in order to compare it with the index of other population and to measure its association with social factors.MethodA set of the PNS variables was selected to carry out the index, taking into account criteria identified in the literature. The FI score was categorized as: non-frail (FI ≥ 0.10); vulnerable (0.10 < FI ≥ 0.21); frail (0.21 < FI ≥ 0.45); and most frail (FI > 0.45). A logistic regression model was adjusted to measure the association of the FI with some risk factors and social factors.ResultsThe Brazilian FI, calculated with 26 variables, presented a mean score of 0.13 and the best was a gamma distribution. Of the individuals, 53.9% were non-frail, 30.1% vulnerable, 13.6% frail and 2.5% most frail. The variables that significantly distinguished each level of the frailty were: self-perceived health status; instrumental activities of daily living (IADL); and difficulty in hearing, seeing and concentrating. Additionally, socio-demographic and sedentary lifestyle were identified as risk factors.ConclusionThe proposed index showed a similar distribution to the ones observed in the literature and it is associated with social factors. These findings are useful to guide the planning of the Brazilian health policy for the elderly population.     

The relationship between frailty and serum alpha klotho levels in geriatric patients

BackgroundFrailty is a medical syndrome resulting in loss of endurance, strength and physiological function. There is insufficient data to understand the process of frailty formation at the gene level, however one of the product of Klotho gene known as an anti-aging gene with many functions that prolong lifespan is alpha klotho protein. We aimed to investigate the relationship between frailty and the serum alpha klotho protein levels.MethodsIn this cross-sectional analysis, there were 89 patients aged 65 years old and older, 45 of whom were frail and 44 of whom were not frail, were included in the study. Within the scope of the study, a sociodemographic and clinical information form, the Turkish version of the FRAIL scale and a comprehensive geriatric assessment were evaluated. In addition to routine laboratory tests, plasma alpha klotho protein levels were measured.ResultsThe mean alpha klotho protein levels of the patients were 0.76 ± 1.01 ng/ml in the control group and 0.54 ± 0.61 ng/ml in the frail group, however, there was no statistically significant difference between the two groups (p = 0.286). C-reactive protein (CRP) levels were significantly higher and hemoglobin (Hb) levels were significantly lower in the frail patients compared to the control group (p < 0.05). It was observed that alpha klotho protein level was inversly correlated with increased CRP levels but association was weak (p = 0.022, R: −0.245). Hb levels (p = 0.018, R: 0.250) was weakly correlated with alpha klotho protein level.ConclusionNo significant relationship was found between frailty and alpha klotho protein levels in the geriatric patients. Further comprehensive studies are needed to explore this subject.     

Health behaviors and their determinants in multiethnic, active Israeli seniors

To assess factors that affect the adoption of healthy lifestyles among a variety of active Israeli seniors, a survey was conducted in 2002 at the Peiluyada, a physical activity-oriented health fair for seniors held annually in Israel from 1995 to 2002. A multi-language, self-administered questionnaire, assessing predisposing factors, barriers and health-protective behaviors, was fielded to potential participants. Response rate at the event was 51%. Hebrew and Arabic speakers generally characterized their health as good to very good, while Russian speakers' health was rated only poor to fair. Over 80% engaged in regular physical activity, were satisfied with their diet, and conformed to international nutritional recommendations. Vaccination coverage against influenza (81%) and pneumocccocus (58%) was highest among Arabic speakers, and lowest among Russian speakers (33.5% and 12%, respectively). Higher age (> or =75 years) was significantly associated with receiving a vaccination against influenza. Major barriers to exercise included low motivation and poor physical health or disability. Health-related dietary restrictions were the leading nutritional barrier. Prominent barriers to vaccination included concerns about vaccine effectiveness (39%) and side effects (29%). Leading cues to action were a recommendation from one's doctor (67%) and from a healthcare worker (51%).     

Constructing and identifying predictors of frailty among homeless adults—A latent variable structural equations model approach

Homeless urbanites are a heterogeneous population with unique health and social service needs. The study examined situational, behavioral, health-related and resource indicators in terms of their direct impact on frailty, hypothesized as a latent variable. Using structural equation modeling (SEM), a model was tested with 150 homeless men and women, ages 40–73, from three homeless day center drop-in sites on Skid Row and one residential drug treatment (RDT) facility that works with homeless parolees and probationers. In bivariate analyses with the latent construct frailty, months homeless (p < 0.01), female gender (p < 0.05), education (p < 0.05), comorbid conditions (p < 0.001), nutrition (p < 0.001), resilience (p < 0.001), health care utilization (p < 0.01), and falls (p < 0.001) were significantly associated with frailty. In the final path model, significant predictors of frailty included educational attainment (p < 0.01), comorbid conditions (p < 0.001), nutrition (p < 0.001), resilience (p < 0.001), and falls (p < 0.01). These findings will serve as a foundation for future nurse-led, community-based initiatives that focus on key predictors of frailty among the homeless and the development of interventions.     

Education,wealth, and duration of life expected in various degrees of frailty

Multistate life tables are used to estimate life expected in three frailty states: frailty free, mild/moderate frailty, severe frailty. Estimates are provided for the combination of education and wealth by age, stratified by sex. Data consider 17,115 cases from the Health and Retirement Study, 2000–2014. Frailty is measured using a 59 item frailty index based on deficit accumulation. Estimates are derived using stochastic population analysis for complex events. Population-based and status-based results are reported. Findings confirm a hypothesis that the combination of higher education and wealth results in longer lives in more favorable degrees of frailty. Also, as hypothesized, wealth generally affords a greater advantage than does education among those with severe frailty at baseline. For instance, high wealth provides a 70-year-old woman with severe frailty at baseline 0.70 more total years and 0.81 more frailty free years then her counterpart with low wealth, compared to gains of 0.39 and 0.54, respectively, for those with high education. Unexpectedly, wealth also has a greater role among those frailty free at baseline. A 70-year-old woman frailty free at baseline with high wealth lives 3.19 more net years and 4.13 more years frailty free than her counterpart with low wealth, while the same comparison for high versus low education indicates advantages of 2.00 total and 1.96 frailty free years. Relative change ratios also indicate more robust results for wealth versus education. In sum, there is evidence that inequality in duration of life in degrees of frailty is socially patterned.Electronic supplementary materialThe online version of this article (10.1007/s10433-020-00587-2) contains supplementary material, which is available to authorized users.     

Effects of social isolation,loneliness and frailty on health outcomes and their possible mediators and moderators in community-dwelling older adults: A scoping review

Background/ObjectivesOver the past decade, the quantity and quality of social relationships in later life have become one of the main challenges facing an aging society. Our aims were to map and synthesize the literature addressing the effects of loneliness, three aspects of social isolation, including social networks, social support, and social participation, and frailty on health outcomes and their mediators and moderators among older adults.MethodsWe conducted a scoping review and searched for articles published in English and French from 2001 up to 2019 in the following databases: Medline, Embase, CINAHL Plus, Scopus, Web of Science and PsycINFO.ResultsOur database search initially resulted in 4001 articles of which 1832 were excluded; 26 were eligible. Most of the included studies revealed associations between social isolation, loneliness and frailty. The majority of studies found evidence of associations between frailty and their adverse outcomes; however, only few studies found a relationship between social isolation and health outcomes. In spite of the established link between frailty and adverse outcomes, no study looked at how social isolation and loneliness can alter adverse outcomes of frailty. No study investigated the role of frailty or social isolation and loneliness as a mediator on the pathway related to health.ConclusionsEvidence is limited in examining the role of frailty or social isolation and loneliness as a moderator and mediator. Longitudinal research combining both social isolation and loneliness are warranted to explore whether social isolation or loneliness has more deleterious effects on frailty and health outcomes.     

Combined effects of frailty status and cognitive impairment on health-related quality of life among community dwelling older adults

ObjectivesThe aim of the present study was to investigate the combined association of frailty/pre-frailty and cognitive impairment with health related quality of life (HRQOL) among community dwelling older adults.MethodsData came from a cross-sectional study of community-dwelling older adults aged 65 years or older, who participated in the 2013 National Health Interview Survey in Taiwan. Frailty was determined based on the Fatigue, Resistance, Ambulation, Illness, and Loss of weight (FRAIL) scale proposed by the International Association of Nutrition and Aging. The Mini-Mental State Examination was used to assess cognitive function. HRQOL was measured using the European Quality of Life-5 Dimensions questionnaire (EQ-5D) that assesses three levels of functioning for the dimensions of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Poisson regression models were performed to estimate prevalence ratios (PR) and 95 % Confidence Intervals (95 % CI) for health problems in all EQ-5D domains.ResultsIn this study, 11.0 % of participants aged 65 years and older had co-occurring frailty/pre-frailty and cognitive impairment. After adjustment for other factors, compared with participants who were physically robust with normal cognition, participants with co-occurring frailty/pre-frailty and cognitive impairment had PRs of 10.38 (95 % CI 7.56–14.26), 9.66 (95 % CI 6.03–15.48), 9.37 (95 % CI 6.92–12.68), 3.04 (95 % CI 2.53–3.64), and 5.63 (95 % CI 3.83–8.28) for reporting problems with mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, respectively.ConclusionsThere is a high prevalence of co-occurrence of frailty/pre-frailty and cognitive impairment in older adults, and this co-occurrence was strongly associated with self-reported health problems across all EQ-5D domains.     

农村与城市80岁以上成功老龄人群生物学指标的比较

目的 了解农村与城市80岁以上成功老龄生物学指标状况.方法 2007年11月随机抽取广西巴马瑶族自治县80岁以上成功老龄73例,同期抽取广西南宁市80岁以上成功老龄31例.测量二组老人的身高、体重、血常规、电解质、血脂、血糖,计算体重指数(BMI),并对影响长寿的相关生物学指标进行多因素回归分析.结果 成功老龄血脂、血糖、血常规、电解质均在正常范围,城市成功老龄的平均年龄小于农村成功老龄,平均体重、身高大于农村成功老龄,超重人数明显多于农村成功老龄,在高密度脂蛋白胆固醇(HDL-C)低的比例、空腹血糖值、平均血红蛋白量、平均血红蛋白浓度、钠、氯、镁高于农村成功老龄,载脂蛋白A(ApoA)、载脂蛋白B(ApoB)、淋巴细胞、中性粒细胞、红细胞、红细胞容积低于农村成功老龄;多因素回归分析,结果显示城市成功老龄的年龄与甘油三酯(TG)呈负相关,农村成功老龄的年龄与BMI、HDL-C呈负相关.结论 城市和农村成功老龄的部分生物学指标存在差异,但成功老龄生物学指标具有正常稳定的特征,而保持正常稳定的生物学基础是以保持正常体重为基准,以科学行为方式和良好生态环境为前提.     

The association between frailty and quality of life when aging in place

Background and objectivesAdvanced age is often associated with frailty, which in turn is associated with low quality of life. This study explores to what extent multidimensional frailty is associated with multidimensional quality of life.Material and methodsA cross-sectional survey study was conducted in a sample of 336 Flemish older people aging in place. Data were collected between 2014 and 2016 using two multidimensional self-reporting instruments; the Comprehensive Frailty Assessment Instrument to assess frailty and the World Health Organization Quality of Life Instrument-Short Version to assess quality of life. Bivariate analyses were used to explore the relationship between quality of life, associated factors of quality of life and frailty.ResultsThe mean age of the respondents was 74.9 years and 71.7% were woman. An inverse correlation was found between frailty and quality of life (r = −.683) and the corresponding subdomains. Nevertheless, some respondents perceived their quality of life as high, although they were defined as mild to high frail. Further analysis indicated that neither socio-demographic factors nor being ill contributed to quality of life.Discussion and implicationsPsychological frailty contributed the most to quality of life. However, the results indicate that frailty does not inevitably leads to a lower quality of life and that other factors, besides frailty, play an important role in determining quality of life. Knowledge about these factors and their mutual relationship can help policymakers and services in providing client-centered care to increase or maintain the quality of life of people aging in place.