Xuxi Zhang

INTRODUCTION  Health‐related quality of life (HRQoL) is a multidimensional construct that specifically focuses  on health‐related aspects of well‐being. It includes elements about physical and mental  functioning, as well as a person’s subjective appraisal of their effect on daily life and social  functioning. 1  For frail people, HRQoL may be restricted. Frailty is a multidimensional syndrome  characterized by the loss of reserves including energy, physical ability, cognition and health  and is highly prevalent with increasing age. 2‐4  As the proportion of the European citizens aged  65 years and older is expected to further rise from 18% in 2013 to 27% in 2040 5 , more people  will suffer from frailty in the near future. 4, 6  Therefore, the literatures of studies regarding the  HRQoL of frail people increase. 6, 7 However, studies on the association between frailty and HRQoL are still scarce and show  contradictory results. 8  Several cross‐sectional studies using generic or specific instruments for  measuring HRQoL reported that frailty is associated with poorer HRQoL among older people. 3,  4, 8‐12  Where some studies found that poor endurance and energy had the strongest effect 3, 4,  12  , another study observed slowness and poor endurance to have the strongest effect on  poorer HRQoL. 9 Because of its multidimensional nature, it has been suggested to consider frailty broadly from  a physical, psychological and social perspective when examining the association between  frailty and HRQoL. 10  However, there is yet no consensus on the associations between the three  domains of frailty and HRQoL. Some studies suggest that psychological and social frailty had  a significant  negative  effect on HRQoL. 10, 13, 14  For example, a cross‐sectional study in The  Netherlands found that psychological and social frailty significantly contributed to the ability  of physical frailty to predict HRQoL. 10  However, one longitudinal study found no significant  effect of social frailty on HRQoL. 15  Thus, more studies on this topic are needed to clarify the  association between the three domains of frailty and HRQoL.  Frailty is a common problem among older people, and study to explore the association  between frailty and HRQoL could provide insight needed for further development of effective  interventions to improve HRQoL. 16  It might provide professionals with starting points to  optimize the (timely) choice of interventions and to establish tailored support for frail people  at risk for suboptimal HRQoL. Understanding HRQoL in frail people could finally help policy  makers develop more precise policies for healthy aging.   The aim of this present study is to evaluate the association between physical, psychological  and social frailty and HRQoL among community‐dwelling older people in five European  countries. We hypothesize that overall frailty is associated with poorer physical and mental  HRQoL. Also, we hypothesize that physical frailty is associated with poorer physical HRQoL,  psychological frailty with poorer mental HRQoL and social frailty with poorer physical and  mental HRQoL.  2 29 Association between frailty and HRQoL