Assessing the psychosocial dimensions of frailty among older adults in Singapore: a community-based cross-sectional study

OBJECTIVE: To examine how multiple dimensions of mental and social health, in addition to physical health, were associated with frailty among older adults. DESIGN: A door-to-door sampling household community-based survey. SETTING: Thirty-two public housing blocks within a residential town in Singapore’s central region. PARTICIPANTS: 497 residents aged 60 years or older from the public housing town. OUTCOME MEASURES: Physical frailty was assessed using the FRAIL Scale, which stands for fatigue, resistance, ambulation, illnesses and loss of weight. Physical health was assessed by multimorbidity, physical activity and functional ability; mental illness was assessed by the General Health Questionnaire (GHQ); and social domains were assessed by the Lubben Social Network Scale, Community Integration Measure and UCLA (University of California, Los Angeles) Loneliness Scale. RESULTS: Compared with robust (59.5%) and prefrail (32.6%) older adults, frail adults (7.9%) reported higher morbidity, lower functional ability and physical activity, higher scores on GHQ, and lower scores on all three social health scales. In multiple regression models, frailty was significantly associated with age 81–90 years (adjusted OR=2.22, 95% CI 1.23 to 3.99), having 2–3 (adjusted OR=1.56, 95% CI 1.02 to 2.38) or >3 (adjusted OR=1.83, 95% CI 1.05 to 3.18) chronic diseases, reduced ability to perform daily tasks without assistance (adjusted OR=0.41, 95% CI 0.23 to 0.73), having fallen in the past 6 months (adjusted OR=2.18, 95% CI 1.18 to 4.06), social dysfunction in GHQ (adjusted OR=1.24, 95% CI 1.08 to 1.43) and loneliness (adjusted OR=1.26, 95% CI 1.06 to 1.50). Physical activity did not remain significantly associated with frailty when mental and social health-related factors were entered in the regression. CONCLUSION: Community intervention for frailty prevention and management needs to include mental health promotion and social engagement to increase its impact on older adults.