Frailty in relation to psycho‐social factors in elderly patients with rheumatoid arthritis: A cross‐sectional mixed qualitative‐quantitative study

AIM: The aim of the study was to explore in patients with rheumatoid arthritis (RA) ≥55 years: (1) whether the occurrence of frailty as measured by the Groningen Frailty Indicator (GFI) increases with age (survey 1); and (2) to gain insight into which frailty characteristics (eg, loneliness) contribute to frailty (survey 2). METHODS: The GFI was assessed in 3 age groups (55‐64/65‐74/≥75‐years), ensuring equal representation. GFI‐subdomains that discriminated most between those classified as frail were further studied in a subset of patients using validated domain‐specific questionnaires (eg Hospital Anxiety and Depression Scale [HADS]) and semi‐structured interviews. Questionnaires were filled out twice: for current age and the recalled situation at age 40, to see whether psychiatric symptomatology might be misinterpreted for frailty. RESULTS: Of 90 patients included, frailty prevalence on the GFI across age groups was 43.3%‐40.0%‐43.4%, respectively. Frail patients often reported depressive (73.7% vs. 11.5%) and anxious (57.9% vs. 15.4%) feelings. There were 32/90 patients who filled out the psycho‐social questionnaires twice. More frail patients had signs of an anxiety disorder on the HADS (missing data 4 patients), both at current age (5/11 frail patients vs. 0/17 non‐frail patients, P = .01) and age 40 (7/11 frail patients vs. 0/0 non‐frail patients, P < .01). During the interviews, especially frail patients reported gloomy feelings, although none confirmed depression or anxiety. CONCLUSIONS: Frailty is highly prevalent in RA patients ≥55 years. As frail patients were characterized by symptoms of anxiety both at current age but (recalled) also at age 40, this finding suggests that pre‐existing psychiatric symptomatology may confound assessment of frailty.