Xuxi Zhang

In the full model, only physical ( p  < 0.001) and social frailty ( p  < 0.05) remained significant.  Living in Greece (vs. Spain), having completed primary education or less/secondary education  or equivalent (vs. tertiary education or higher), living alone and smoking were not significantly  associated with the PCS score.   Psychological frailty had the strongest association with mental HRQoL. In the adjusted models,  the mean MCS score of physically frail participants was 4.08 lower than that of not physically  frail participants ( p < 0.001). For psychologically frailty this figure amounted to 9.58 ( p < 0.001)  and for social frailty to 5.87 ( p  < 0.001). Among the three adjusted models, the amount of  variance explained was largest for psychological frailty (36.8%).   In the full model, physical, psychological and social frailty each remained significant ( p < 0.001).  Living in Greece or the Netherlands (versus Spain), having completed secondary education or  equivalent (versus Tertiary education or higher), high‐risk alcohol use, smoking and multi‐ morbidity were not significantly associated with the MCS score.  DISCUSSION  The aim of this study was to explore the association between physical, psychological and social  frailty versus HRQoL among community‐dwelling older people in five Europe countries.  Consistent with previous studies, our results show that frail people have a poorer physical and  mental HRQoL than not frail people. 3, 4, 8, 16, 29  This also holds for physical, psychological and  social frailty separately. 29, 30 Physical frailty   Our findings confirm that physical frailty has the strongest association with physical HRQoL.  Also, the addition of physical frailty contributed to the ability of psychological frailty to explain  mental HRQoL. A study in the Netherlands also found that the prevalence rate of physical  frailty among depressed participants was higher than that of non‐depressed participants, and  physical frailty was associated with more severe depressive symptoms, which might because  physical frailty may result in more severe mental disorders due to its association with chronic  somatic disease and functional limitations. 31  However, studies on this topic are scarce, and  studies on physical frailty and mental HRQoL are needed to confirm our findings.  Psychological frailty   Psychological frailty had the strongest association with mental HRQoL. However, psychological  frailty did not contribute to the ability of physical frailty to explain physical HRQoL. The latter  is in contrast to earlier studies 10, 15 , which may be explained by the fact that previous studies  adopted the WHOQOL‐BREF instead of SF‐12 to measure HRQoL and did not classify HRQoL  into physical and mental HRQoL. More studies are still needed to clarify these findings.   38 Chapter 2