A four-domain approach of frailty explored in the Doetinchem Cohort Study

BMC Geriatr. 2017 Aug 30;17(1):196. doi: 10.1186/s12877-017-0595-0.


Background: Accumulation of problems in physical, psychological, cognitive, or social functioning is characteristic for frail individuals. Using a four-domain approach of frailty, this study explored how sociodemographic and lifestyle factors, life events and health are associated with frailty.

Methods: The study sample included 4019 men and women (aged 40-81 years) examined during the fifth round (2008-2012) of the Doetinchem Cohort Study. Four domains of frailty were considered: physical (≥4 of 8 criteria: unintentional weight loss, exhaustion, strength, perceived health, walking, balance, hearing and vision impairments), psychological (2 criteria: depressive symptoms, mental health), cognitive (<10th percentile on global cognitive functioning), and social frailty (≥2 of 3 criteria: loneliness, social support, social participation). Logistic regression was used to study the cross-sectional association of sociodemographic factors, lifestyle, life events and chronic diseases with frailty domains.

Results: About 17% of the population was frail on one or more domains. Overlap between the frailty domains was limited since 82% of the frail population was frail on one domain only. Low educated respondents were at higher risk of being psychologically and socially frail. Having multiple diseases was associated with a higher risk of being physically and psychologically frail. Being physically active was consistently associated with a lower risk of frailty on each of the four domains. Short or long sleep duration was associated with a higher risk of being physically, psychologically, and socially frail.

Conclusions: Sociodemographic factors, lifestyle and multimorbidity contributed differently to the four frailty domains. It is important to consider multiple frailty domains since this helps to identify different groups of frail people, and as such to provide tailored care and support. Lifestyle factors including physical activity, smoking and sleep duration were associated with multiple domains of frailty.

Keywords: Frailty; Lifestyle; Multidimensional; Physical activity; Prospective cohort; Sleep.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Chronic Disease
  • Cohort Studies
  • Female
  • Frail Elderly / psychology
  • Frail Elderly / statistics & numerical data
  • Frailty* / diagnosis
  • Frailty* / epidemiology
  • Frailty* / psychology
  • Health Status
  • Humans
  • Life Change Events
  • Life Style
  • Male
  • Mental Health
  • Middle Aged
  • Netherlands / epidemiology
  • Social Participation
  • Social Support
  • Sociological Factors