Self-management abilities and frailty are important for healthy aging among community-dwelling older people; a cross-sectional study

BMC Geriatrics

Anna P Nieboer¹  Jos Twisk²  Jane M Cramm¹ 

[1] Institute of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam 3000 DR, The Netherlands;Department of Methodology and Applied Biostatistics, Institute of Health Sciences, Faculty of Earth and Life Science, Vrije Universiteit, Amsterdam, The Netherlands

关键词: Health;    Frailty;    Self-management;    Netherlands;    Community study;   

Others  :  855333
DOI  :  10.1186/1471-2318-14-28

 received in 2013-05-30, accepted in 2014-02-27,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Cramm et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]World Health Organization: The Global Strategy on Diet, Physical Activity and Health. Geneva: World Health Organization; 2004.
• [2]Baltes PB, Baltes MM: Psychological perspectives on successful aging: the model of selective optimization with compensation. In Successful Aging: Perspectives from the Behavioral Sciences. Edited by Baltes PB, Baltes MM. Cambridge: Cambridge University Press; 1990:1-34.
• [3]Clark NM, Janz NK, Becker MH, Schork MA, Wheeler J, Liang J, Dodge JA, Keteyian S, Rhoads KL, Santinga JT: Impact of self-management education on the functional health status of older adults with heart disease. Gerontologist 1992, 32:438-443.
• [4]Hopman-Rock M, Westhoff MH: The effects of a health educational and exercise program for older adults with osteoarthritis for the hip or knee. J Rheumatol 2000, 27:1947-1954.
• [5]Holman HR, Lorig KR: Overcoming barriers to successful aging. Self-management of osteoarthritis. West J Med 1997, 167:265-268.
• [6]von Faber M, Bootsma-van der Wiel A, van Exel E, Gussekloo J, Lagaay AM, van Dongen E, Knook DL, van der Geest S, Westendorp RG: Successful aging in the oldest old: who can be characterized as successfully aged? Arch Intern Med 2001, 161:2694-2700.
• [7]Steverink N, Lindenberg S, Slaets JPJ: How to understand and improve older people’s self-management of wellbeing. Eur J Ageing 2005, 2:235-244.
• [8]Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research Group: Frailty in older adults: evidence for a phenotype. J Gerontol A Bio Sci Med Sci 2001, 56:146-156.
• [9]Gill TM, Gahbauer EA, Allore HG, Han L: Transitions between frailty states among community-living older persons. Arch Intern Med 2006, 166(4):418-423.
• [10]Slaets JP: Vulnerability in the elderly: frailty. Med Clin North Am 2006, 90(4):593-601.
• [11]Rockwood K, Stadnyk K, MacKnight C, McDowell I, Hebert R, Hogan DB: A brief clinical instrument to classify frailty in elderly people. Lancet 1999, 353:205-206.
• [12]Winograd CH, Gerety MB, Chung M, Goldstein MK, Dominguez F Jr, Vallone R: Screening for frailty: criteria and predictors of outcomes. J Am Geriatr Soc 1991, 39:778-784.
• [13]Campbell AJ, Buchner DM: Unstable disability and the fluctuations of frailty. Age Ageing 1997, 26:315-318.
• [14]Winograd CH: Targeting strategies: an overview of criteria and outcomes. J Am Geriatr Soc 1991, 39S:25S-35S.
• [15]Verbrugge LM, et al.: Flies without wings. In Longevity and frailty. Edited by Carey R, Robin J-M, Michel J-P. Heidelberg (Germany): Springer; 2005:67-81.
• [16]Bauer JM, Sieber CC: Sarcopenia and frailty: a clinician’s controversial point of view. Exp Gerontol 2008, 43:674-678.
• [17]Bergman H, Beland F, Lebel P, Contandriopoulos AP, Tousignant P, Brunelle Y, Kaufman T, Leibovich E, Rodriguez R, Clarfield M: Caring for Canada’s frail elderly population: fragmentation or integration? CMAJ 1997, 157:1116-1120.
• [18]Markle-Reid M, Browne G: Conceptualizations of frailty in relation to older adults. J Adv Nurs 2003, 44(1):58-68.
• [19]Gobbens RJJ, van Assen MALM, Luijkx KG, Wijnen-Sponselee MT, Schols JMGA: The Tilburg Frailty Indicator: psychometric properties. J Am Med Dir Assoc 2010, 11(5):344-355.
• [20]Levers MJ, Estabrooks CA, Ross Kerr JC: Factors contributing to frailty: literature review. J Adv Nurs 2006, 56(3):282-291.
• [21]Pel Littel RE, Schuurmans MJ, Emmelot Vonk MH, Verhaar HJ: Frailty: defining and measuring of a concept. J Nutr Health Aging 2009, 13(4):390-394.
• [22]McNallan SM, Singh M, Chamberlain AM, Kane RL, Dunlay SM, Redfield MM, Weston SA, Roger VL: Frailty and healthcare utilization among patients with heart failure in the community. JACC Heart Fail 2013, 1(2):135-141.
• [23]Robinson TN, Wu DS, Stiegmann GV, Moss M: Frailty predicts increased hospital and six-month healthcare cost following colorectal surgery in older adults. Am J Surg 2011, 202(5):511-514.
• [24]Daniels R, Metzelthin S, Van Rossum E, De Witte L, Van den Heuvel W: Interventions to prevent disability in frail community-dwelling older persons: an overview. Eur J Ageing 2010, 7(1):137-155.
• [25]Strandberg TE, Strandberg A, Salomaa VV, Pitkälä K, Tilvis RS, Miettinen TA: The association between weight gain up to midlife, 30-year mortality, and quality of life in older men. Arch Intern Med 2007, 167((20):2260-2261.
• [26]Steverink N, Lindenberg S: Do good self-managers have less physical and social resource deficits and more well-being in later life? Eur J Ageing 2008, 5:181-190.
• [27]Schuurmans H, Steverink N, Frieswijk N, Buunk BP, Slaets JP, Lindenberg S: How to measure self-management abilities in older people by self-report? The development of the SMAS-30. Qual Life Res 2005, 14:2215-2228.
• [28]Cramm JM, Hartgerink JM, de Vreede PL, Bakker TJ, Steyerberg EW, Mackenbach JP, Nieboer AP: The role of self-management abilities in the achievement and maintenance of well-being, prevention of depression and successful aging. Eur J Aging 2012, 9(4):353-360.
• [29]Cramm JM, Hartgerink JM, Steyerberg EW, Bakker TJ, Mackenbach JP, Nieboer AP: Understanding older patients’ self-management abilities: functional loss, self-management, and well-being. Qual Life Res 2012, 22(1):85-92.
• [30]Cramm JM, Strating MMH, de Vreede PL, Steverink N, Nieboer AP: Development and validation of a short version of the Self-Management Ability Scale (SMAS). Health Qual Life Out 2012, 10:9. BioMed Central Full Text
• [31]Wen M, Browning CR, Cagney KA: Poverty, affluence, and income inequality: neighborhood economic structure and its implications for health. Soc Sci Med 2003, 57:843-860.
• [32]Idler EL, Kasl SV: Self-ratings of health: do they predict change in functional ability? J Gerontol Soc Sci 1995, 50:344-353.
• [33]Idler EL, Benyamanini Y: Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 1997, 38:21-37.
• [34]Mossey JM, Shapiro E: Self-rated health: a predictor of mortality among the elderly. Am J Pub Health 1982, 72:800-808.
• [35]Lindsay S: How and why the motivation and skills to self-manage coronary heart disease are socially unequal. Res Sociol Health Care 2008, 26:17-39.
• [36]Lindsay S: The influence of childhood poverty on the self-management of chronic conditions in later life. Res Sociol Health Care 2009, 27:161-183.
• [37]Picavet HSJ: National health surveys by mail or home interview. Effects on response. J Epidemiol Community Health 2001, 55:408-413.
• [38]Buttle F, Thomas G: Questionnaire colour and mail survey response rate. J Mark Res Soc 1997, 39:625-626.
• [39]Frieswijk N, Steverink N, Buunk BP, Slaets JPJ: The effectiveness of a bibliotherapy in increasing the self-management ability of slightly to moderately frail older people. Patient Educ Couns 2006, 61:219-227.
• [40]Schuurmans H: Promoting well-being in frail elderly people: theory and intervention. GRoningen Intervention Program (GRIP). Dissertation, University of Groningen, 2004Available at: http://opc.ub.rug.nl webcite