Frailty in relation to psycho-social factors in elderly patients with rheumatoid arthritis: A cross-sectional mixed qualitative-quantitative study

Aim The aim of the study was to explore in patients with rheumatoid arthritis (RA) >= 55 years: (1) whether the occurrence of frailty as measured by the Groningen Frailty Indicator (GFI) increases with age (survey 1); and (2) to gain insight into which frailty characteristics (eg, loneliness) contribute to frailty (survey 2).

Methods The GFI was assessed in 3 age groups (55-64/65-74/>= 75-years), ensuring equal representation. GFI-subdomains that discriminated most between those classified as frail were further studied in a subset of patients using validated domain-specific questionnaires (eg Hospital Anxiety and Depression Scale [HADS]) and semi-structured interviews. Questionnaires were filled out twice: for current age and the recalled situation at age 40, to see whether psychiatric symptomatology might be misinterpreted for frailty.

Results Of 90 patients included, frailty prevalence on the GFI across age groups was 43.3%-40.0%-43.4%, respectively. Frail patients often reported depressive (73.7% vs. 11.5%) and anxious (57.9% vs. 15.4%) feelings. There were 32/90 patients who filled out the psycho-social questionnaires twice. More frail patients had signs of an anxiety disorder on the HADS (missing data 4 patients), both at current age (5/11 frail patients vs. 0/17 non-frail patients, P = .01) and age 40 (7/11 frail patients vs. 0/0 non-frail patients, P < .01). During the interviews, especially frail patients reported gloomy feelings, although none confirmed depression or anxiety.

Conclusions Frailty is highly prevalent in RA patients >= 55 years. As frail patients were characterized by symptoms of anxiety both at current age but (recalled) also at age 40, this finding suggests that pre-existing psychiatric symptomatology may confound assessment of frailty.