In the study, health-related factors affecting the frailty of the subjects were derived from CGA of the patients participating in the study. Among factors that had a statistically significant effect on frailty, BMI was significantly lower in frail group (p-value < 0.001). Sleep problems(p-value < 0.001), lack of social activities (p-value = 0.002), and high pain grades(p-value = 0.015) significantly more frequent in frail group.
The mean BMI among frail group was (19.4 ± 3.7) with under-weight (51.4%), this was agreed with Xu et al., 2020, Wu et al., 2021 Au et al.,2021, Bichels et al.,2021. Rietman et al., 2018. U-shaped association was observed between BMI and physical frailty; underweight as well as obesity is associated with physical frailty. Our results may be attributed to our sample gender being only males, compared to previous studies frail males and females were included. Higher overweight prevalence is observed more frequently among females, compared to higher underweight prevalence among frail males (Jayanama et al., 2022).
Frail group reported high pain grades (65.7%) compared to control group (15%). This agreed with Pedro et al., 2019, Yamada et al., 2018, Chen et al., 2019, who found that, there is an association between chronic pain and frailty in terms of prevalence. With higher prevalence among underweight frail males Yamada et al., 2018, sleep problems Hiroya et al., 2022 and depression liu et al., 2021. Chronic pain in frail elderly mediates sleep disorders and influences falls. Hiroya et al., 2022.
Sleep problems show higher prevalence among frail group (80%), compared to (34.3%) among controls, our study is consistent with, Pourmotabbed et al., 2020, Lorber et al., 2023 and Madan et al., 2023. daytime drowsiness, sleep disordered breathing, and prolonged sleep latency enhanced the risk of frailty Pourmotabbed et al., 2020. Higher sleep fragmentation index was associated with frailty and mortality. Greater wake after sleep onset and lower percent sleep were associated with mortality Guida et al., 2021.
As regards lack of social activities, it was more prevalent among frail group (71.4%), than control (34.3%). our study agreed with Davies et al., 2021, Mehrabi et al., 2020 and Gale et al., 2018, high levels of loneliness and social isolation were associated with an increased risk of becoming physically frail or pre-frail later especially in men.
As regard comprehensive geriatric assessment, MNA and IADL were significantly lower in the frail group(p-value < 0.001). GDS score was significantly higher in the frail group. (p-value < 0.001)
We found that malnutrition/ at risk was significantly more frequent in the frail group (68.6%), compared to control (22.9%), these findings agreed with Zhang et al., 2022, O'Leary et al., 2020,
As regard IADL. frail elderlies were more dependent (IADL scores 4.6 ± 0.9) compared to control group (IADL scores 7.7 ± 0.7). our study agreed with a systematic review by Zamudio-Rodríguez et al., 2020, Pérez-Ros et al., 2020 Kojima 2016. Overall, frail older people were more likely to develop or worsen disabilities in ADL and IADL.
Although in our study we excluded elderly with depression, frail elderly scored higher in GDS (3.4 ± 0.8) compared to lower GDS scores in control group (1.6 ± 1.3). Wang et al., 2023, Buigues et al.,2015 Nascimento et al., 2016 concluded that depression is more prevalent among frail elderly with higher susceptibility among female, aged 75–79 years, with lower schooling and income, widow/widowers, higher number of disabilities and diseases, and those who met the criteria for frailty and pre-frailty. (Woldesemayat et al., 2023)
Co-morbidities Numbers was significantly higher in the frail group (2.7 ± 1.4) compared to (1.9 ± 1.1). DM was significantly more frequent in frail group (57.1%). We agreed with Vetrano et al., 2019, Hanlon et al., 2018 that there is a bidirectional association between multimorbidity and frailty. Most frail individuals are also multimorbid, but fewer multimorbid ones also present frailty. multimorbidity also increase the risk of mortality in frail patients.
Hubbard et al., 2010 and Bundó et al., 2023 concluded that Frail older adults were 2.62 times more likely to have a complication of diabetes, independent of age, sex and number of years living with diabetes.
Overall, there was no statistical difference regarding number of medications between frail (mean = 5.1 ± 3) and non-frail group (mean = 4.8 ± 1.8). Administration of Statin (45.7%in frails) (71.4% in controls), ACEI (34.3%in frails) (62.9% in controls) and Aspocid (34.3%in frails) (60% in controls) were significantly less frequent in frail group. Our study agreed with ÖZTÜRK et al., 2023, Yoshimura et al., 2022, Hanna et al., 2022, that frail elderly take fewer protective medications. This could be due to financial burden, drugs adverse effect, care giver issues, advanced age, negative believes about usefulness of such medication in advanced age and its role in decreasing mortality/ morbidity. Mantelli et al., 2018 in a cross-sectional survey in Swiss GPs; 98% of GPs deprescribed at least one medication for no indication/ no added benefit if frail elderly, this including: aspirin, enalapril, amlodipine, and pantoprazole, atorvastatin, antidepressant and tramadol.
Self-efficacy as measured by SES was25.3 ± 5 in frail group and 28.1 ± 4.6% in control group) and optimism as measured by R-LOT was 12.7 ± 3.3 in frail group and 16.6 ± 4.4 in control group. SES and R-LOT scores were significantly lower in the frail group, with positive correlation between R-LOT and SES scores. Self-Efficacy was significantly lowest in cases with low Optimism as measured by R-LOT with no significant difference between moderate and high grades.
We explored the relationship between frailty and both self-efficacy and optimism as possible psychosocial determinants of physical frailty. Self-efficacy by definition” is an individual's belief in his or her capacity to execute behaviours necessary to produce specific performance attainments” (Bandura, 1997). Self-efficacy represents confidence in the ability to exert control over one's own motivation, behaviour, and social environment. Enhancing self-efficacy can improve the outcomes and quality of life for patients living with chronic diseases (Farley, 2019).
As regard self-efficacy we concluded that there is negative corelation between self- efficacy and frailty. Our study agreed with Li et al., 2022, Lin CH et al., 2022, Hladek et al., 2020 Doba et al., 2016. That frail elderly show low levels of self-efficacy; elderly with high coping self-efficacy is associated with lower odds of pre-frailty/frailty even with chronic disease.
On the other hand, dispositional Optimism -by definition- is the generalized, relatively stable tendency to expect good outcomes across important life domains (Scheier et al., 2018). The relation between dispositional optimism and better adjustment to diverse stressors may be attributable to optimism's effects on coping strategies (Nes et al.,2006). there is negative corelation between dispositional optimism and frailty. Optimistic seniors cope better with aging/ life stressors, In Wang et al., 2022 study, optimism, resilience, higher levels of tenacity, strength were associated with lower prevalence of frailty. This agreed with Wang et al., 2022, Kim & Won ,2022 Sardella et al., 2021.