title: Psychological well-being in relation to frailty: a frailty identity crisis?
abstract: BACKGROUND
  Frailty can be defined as the presence of multiple, interacting medical and functional problems. Frailty is associated with psychiatric conditions but its relation to psychological well-being is unclear. A "frailty identity crisis" has been proposed as a maladaptive response to the sense of self as health deficits accumulate. We evaluated this so-called identity crisis by investigating associations between well-being, frailty, and mortality in community-dwelling older Canadians.
  
  
  METHODS
  In this secondary analysis of the Canadian Study of Health and Aging (N = 5,703; age 70+), frailty was defined by an index of 33 health deficits. Psychological well-being was measured using Ryff's 18-item scale, with six domains (autonomy, personal growth, environmental mastery, positive relations, purpose in life, and self-acceptance). Cognition was measured using the Modified Mini-Mental State Examination. Associations between well-being, frailty, and mortality were measured using linear regression, adjusting for age, sex, education, cognition, and mental health.
  
  
  RESULTS
  For each additional frailty-defining deficit, the psychological well-being score worsened by 0.3 points (0.29, 95% CI: 0.22-0.36, p < 0.001), independent of age, sex, education, cognition, and mental health. Among the six domains of well-being, only "purpose in life" and "autonomy" were not associated with frailty (all others, p < 0.001). Worse psychological well-being was associated with five-year mortality independent of age, sex, education, frailty, and mental health; this association was not statistically significant when adjusting for baseline cognition.
  
  
  CONCLUSIONS
  Frailty was associated with low levels of well-being. Psychological well-being impaired by a frailty identity crisis may play an important role in defining subjective health in older adults.
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. mandrew@dal.ca
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Andrew
authors.forename: John D
authors.initials: JD
authors.lastname: Fisk
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rockwood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D003866:Depressive Disorder / Q000175:diagnosis / Q000401:mortality / Q000523:psychology; D004522:Educational Status; D005260:Female; D016330:Frail Elderly / Q000523:psychology* / Q000706:statistics & numerical data; D015577:Geriatric Assessment; D006801:Humans; D007063:Identity Crisis; D008297:Male; D011788:Quality of Life / Q000523:psychology*; D012649:Self Concept; D012737:Sex Factors; D011795:Surveys and Questionnaires; D016019:Survival Analysis