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Background: Up to 36% of adults living with rheumatoid arthritis (RA) are frail, a state of increased vulnerability with reduced physical function, increased risk of comorbidities, dependency, and diminished quality of life [1]. Frailty is also associated with psychological challenges, including heightened risks of anxiety and depression, and impairment of self-management. Frailty further poses a significant economic challenge due to increased healthcare utilization and the need for long-term care. Advances in the treatment of RA have led to improved outcomes, resulting in a growing number of people with RA living longer. As the population of aging people with RA expands, the risk of frailty, which increases with age, becomes a significant concern. Consequently, addressing frailty is vital for ensuring effective care and enhancing the quality of life for the aging group of people with RA. Understanding the experiences of frailty in people with RA is essential to inform targeted interventions and support strategies that can improve quality of life, enhance self-management, and reduce healthcare costs.
Objectives: The purpose of this study was to explore how frailty is experienced by people over 65 years living with RA.
Methods: This explorative qualitative interview study utilized purposeful maximum variation sampling. Participants were recruited from a rheumatology outpatient clinic through their entry in the DANBIO system, a patient register which follows patients with inflammatory arthritis prospectively [2]. A Multidimensional Health Assessment Questionnaire (MD-HAQ) score above 1, indicating challenges in managing daily activities, a diagnosis of RA, and an age above 65, triggered a pop-up invitation to participate in the study. Following, patients, who noted an interest in participation were screened for frailty via telephone, using The Clinical Frailty Scale (CFS) [3]. Patients scoring between 4-7, indicating pre-frailty, mild, moderate or severe frailty respectively, were included in the study. We aimed towards a maximal variation sample in terms of frailty based on CFS score, sex, and age. We developed an interview guide based on existing literature and key informant interviews with an older couple (husband with RA and frailty and his wife), who provided insights into living with frailty and RA (e.g., impact of frailty on RA, dependency on others, and personal aspirations). We conducted semi-structured individual interviews, which were audiotaped, transcribed, and managed using NVivo15. The analysis employed a reflexive thematical analysis approach.
Results: In total, 17 participants were included (female n=10, mean age 75 years (range 67-84)). The participants were pre-frail (CFS 4, n=4), mildly frail (CFS 5, n=6), and moderately frail (CFS 6, n=7). It was not possible to include any participants with severe frailty (CFS 7). The mean duration of living with a diagnosis of RA was 23.6 years (range 9 months- 54 years). The analysis resulted in identification of five main themes, each with two sub-themes (Table 1): 1) “Frailty through different lenses: a dual perspective of body and mind” refers to how frailty is tied to feelings of loss of control and can be perceived both in a physical and mental perspective. 2) “When frailty becomes the third wheel in the relationship” highlights how frailty disrupts the balance in a partnership, making both the person with RA and their partner vulnerable. Frailty imposes a shift of roles, and creates emotional strain, affecting the couple’s intimacy and dynamic. 3) “The necessity of decisiveness as a response to frailty” describes how managing RA and compensating for frailty requires mental, physical, and financial resources. 4) “ A bitter farewell to the aging life once imagined ” describes how frailty forces the participants to compromise on the ideals they had for a good senior life with RA, leading to a sense of lost identity as frailty gradually sets in. 5) “ The healthcare system – an unwanted but essential companion ” entails participants’ recounts of being dependent on a responsive and coordinating healthcare system including unmet needs in relation to being seen as a whole person. See Figure 1 for selected quotes.
Table 1. Overview of the main themes and subthemes
Selected quotes
Conclusion: This study highlights the perspectives of older people with RA experience frailty, emphasizing its significant impact on both the relational, physical and psychological aspects of managing their condition. The complex interplay between frailty and RA complicates self-management, posing challenges to navigate both the physical limitations of the disease and the emotional burden of increased dependence on others. These findings stress the importance of addressing frailty as a central element in the care of older people with RA. Furthermore, it emphasizes the necessity of enhanced collaboration across healthcare sectors to ensure comprehensive care, working together to address both the medical and psychosocial needs of this vulnerable population.
REFERENCES: [1] DOI: 10.12688/wellcomeopenres.17208.2.
[2] DOI: 10.2147/CLEP.S141438.
[3] DOI: 10.1186/s12877-020-01801-7.
Acknowledgements: NIL.
Disclosure of Interests: Signe Marie Abild: None declared. Julie Midtgaard: None declared. Charlotte Werdal Hansen: None declared. Luise Lindgren: None declared. Pernille Fevejle Cromhout The employment at Novo Nordisk A/S is in no way related to the planning, execution, or any other relevant aspects of this study. Katrine Piper: None declared. Bente Glintborg Research grants (paid to institution and not this specifik study) AbbVie, Pfizer, Sandoz, EliLilly, AlfaSigma, Tanja Thomsen: None declared. Bente Appel Esbensen: None declared.
© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (