title: Self-management abilities and frailty are important for healthy aging among community-dwelling older people; a cross-sectional study.
abstract: BACKGROUND
  This study aimed to identify the relationships of self-management abilities and frailty to perceived poor health among community-dwelling older people in the Netherlands while controlling for important individual characteristics such as education, age, marital status, and gender.
  
  
  METHODS
  The cross-sectional study sample consisted of 869/2212 (39% response rate) independently living older adults (aged ≥70 years) in 92 neighborhoods of Rotterdam. In the questionnaires we assessed self-rated health, frailty using the Tilburg Frailty Indicator (TFI) and self-management abilities with the short version of the Self-Management Ability Scale (SMAS-S). We first used descriptive analysis to identify those in poor and good health. Differences between groups were established using chi-squared and t-tests. Relationships between individual characteristics, frailty, self-management abilities and poor health were investigated with correlation analyses. Multilevel logistic regression analyses were than performed to investigate the relationships of self-management abilities and frailty to health while controlling for age, gender, education, and marital status. The results of the multilevel regression analyses are reported as odd ratios.
  
  
  RESULTS
  Respondents in poor health were older than those in good health (78.8 vs. 77.2; p ≤ .001). A significantly larger proportion of older people in poor health were poorly educated (38.4% vs. 19.0%; p ≤ .001) and fewer were married (33.6% vs. 46.3%; p ≤ .001). Furthermore, older people in poor health reported significantly lower self-management abilities (3.5 vs. 4.1; p ≤ .001) and higher levels of frailty (6.9 vs. 3.3; p ≤ .001). Correlation analyses showed significant relationships between frailty, self-management abilities and poor health. Multilevel analyses showed that, after controlling for background characteristics, self-management abilities were negatively associated with poor health (p ≤ .05) and a positive relationship was found between frailty and poor health (p ≤ .05) among older people in the community.
  
  
  CONCLUSIONS
  Self-management abilities and frailty are important for healthy aging among community-dwelling older people in the Netherlands. Particularly vulnerable are the lower educated older adults. Interventions to improve self-management abilities may help older people age healthfully and prevent losses as they age further.
authors.affiliation: Institute of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam 3000 DR, The Netherlands. cramm@bmg.eur.nl.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Cramm
authors.forename: Jos
authors.initials: J
authors.lastname: Twisk
authors.forename: Anna P
authors.initials: AP
authors.lastname: Nieboer
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D016330:Frail Elderly / Q000523:psychology*; D006304:Health Status; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D012111:Residence Characteristics; D012648:Self Care / Q000379:methods / Q000523:psychology* / Q000592:standards*; D011795:Surveys and Questionnaires / Q000592:standards