Self‐efficacy proxy predicts frailty incidence over time in non‐institutionalized older adults

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 69; no. 12; pp. 3507 - 3518
• Main Authors: Hladek, Melissa D., Zhu, Jiafeng, Buta, Brian J., Szanton, Sarah L., Bandeen‐Roche, Karen, Walston, Jeremy D., Xue, Qian‐Li
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-12-2021; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; Aging; behavior change; Chronic illnesses; Female; Frail Elderly - psychology; Frailty; Frailty - epidemiology; Frailty - psychology; Geriatric Assessment; Health Behavior; healthy aging; Humans; Incidence; Independent Living - psychology; Male; Older people; personal mastery; Phenotypes; Proportional Hazards Models; Self Efficacy; stress response; United States - epidemiology; United States; personal mastery; stress response; healthy aging; behavior change
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.17417

Background
Physical frailty is defined as a syndrome of decreased physiologic reserve conferring vulnerability to functional decline, mortality, and other adverse outcomes upon experiencing stressors. Self‐efficacy, which is confidence in one's ability to perform well in a domain of life, is modifiable. Self‐efficacy is associated with improved health behavior and decreased chronic disease burden. Its relationship to frailty is unknown. The purpose of this study was to evaluate whether a general self‐efficacy proxy predicts incident frailty.
Methods
A nationally representative sample of 4825 U.S. older adults aged 65 and older living in the community or non‐nursing home care setting enrolled in the National Health and Aging Trends Study from 2011 to 2018 was used. Self‐efficacy was dichotomized into low and high groups using the one‐item self‐efficacy proxy measure. The Physical Frailty Phenotype was used to categorize participants as frail and non‐frail. A discrete time hazard model using data from eight rounds was used to obtain incident hazard ratios of frailty in two models. Model 1 was adjusted for age, race, sex, education, and income. Model 2 contained Model 1 covariates and added disability and comorbidities.
Results
Among people without frailty at baseline, risk of developing frailty over 7 years was increased by 41% among those with low versus high self‐efficacy after adjustment for sociodemographics (P = 0.002), and by 27% after further adjustment for disability and comorbidities (P = 0.032).
Conclusion
This study generates a rationale to further explore self‐efficacy in frailty research. Self‐efficacy may be a key modifiable element to incorporate into multimodal physical frailty interventions.