Self-efficacy and Optimism in frail elderly men without functional disability attending geriatric outpatient clinic in Mansoura university: a case-control study.

Self-efficacy and Optimism in frail elderly men without functional disability attending geriatric outpatient clinic in Mansoura university: a case-control study. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Self-efficacy and Optimism in frail elderly men without functional disability attending geriatric outpatient clinic in Mansoura university: a case-control study. Doaa Ageez This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3244949/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Psychological frailty including cognitive, mood, and motivational components has a major impact on the well- being of frail elderly. Therefore, there is an increasing scientific interest in studying different domains of psychological frailty. Unfortunately, the psychological components of frailty are not completely evaluated and currently there is no consensus regarding appropriate intervention. This study aimed to evaluate self-efficacy and optimism in frail elderly without functional disability. This case-control study was conducted between August 2022 and March 2023, and included 70 elderly male community dwelling participants aged ≥ 60 years. The participants were divided into 2 groups: frail and non-frail defined by AVILA modification of Fried criteria. Self-efficacy scale (SES) and Revised-Life orientation test (R-LOT) were applied for all participants. Results Those with physical frailty had lower self-efficacy and optimism scores. R-LOT and SES had moderate diagnostic accuracy in predicting frailty; AUC for both tools were 0.75 and 0.71, respectively. Conclusions Psychological determinants of frailty are as equally important to be addressed as factors affecting physical frailty. self-efficacy and optimism are both affected in frail elderly. The Self-efficacy scale (SES) and the Revised-Life orientation test (R-LOT) should be applied as a measure of psychological resilience during comprehensive assessment of physical frailty to improve overall well-being and resilience among frail elderly. Geriatrics & Gerontology Psychiatry frailty self-efficacy optimism SES (self-efficacy scale) R-LOT (revised- life orientation test) Figures Figure 1 Figure 2 Figure 3 Background Frailty is an emerging international health burden, with major implications for clinical practice and public health. The prevalence of frailty is exponentially rising alongside with rapid growth in the ageing population ( Hoogendijk et al., 2019 ). “Frailty” is a state of loss of resilience and enhanced vulnerability to stressors ( Joseph et al., 2023 ), which leads to adverse outcomes such as falls, dependence, hospitalization, institutionalization, and death ( Howlett et al., 2021 ). Frailty as a broad term has multidimensional nature of the deficit accumulation. The biopsychosocial model of frailty explains frailty as a multidimensional condition including physical, cognitive, social, and psychological domains (Morley,2017). Psychological frailty is a complex concept with multiple components. It should include both mental features and physical frailty. Jinlong Zhao and his colleagues identified a set of components that were most frequently used to capture the scope of psychological frailty: mood problems, cognitive problems, mental health problems and fatigue associated problems ( Zhao et al., 2023 ). Psychological resilience refers to “the capacity of an individual to cope in the face of stressors and adversity, allowing individuals to successfully maintain their physical and mental health” ( Afek et al., 2021 ). Dispositional optimism is commonly recognized as a psychological factor able to promote resilience and to promote a positive adaptation to aging ( Taylor & Carr, 2021 ). Optimism as a cognitive construct is “the positive expectations regarding future outcomes, which is related to motivation” (Carver et al., 2014) . Koga and her colleagues showed that higher levels of optimism were associated with greater probability of achieving exceptional longevity (Koga et al.,2022 , as optimistic people are encouraged to embrace healthy lifestyle, such as engaging in physical activity, healthy diet, and cessation of smoking (Dos Santos et al., 2018 ). Self-efficacy is defined as “confidence to perform a specific behaviour or succeed in a specific life domain, which is attained through four distinct mechanisms: personal mastery, physiologic feedback, verbal persuasion, and vicarious experience” ( Bandura, 1997 ). Coping self-efficacy is a domain-specific concept of confidence to cope effectively with difficulties in the areas of problem solving, emotional regulation and obtaining support from one’s social network ( Chesney et al., 2006 ). This is especially important in addressing “frailty identity crisis” along the life course of frail elderly, thus influence easy transitioning and alleviate unpleasant drawbacks ( Li et al., 2022 ). Self-efficacy is malleable and was successfully targeted in health-related interventions, making it a potentially useful intervention goal for the treatment of frailty. Increase in self-efficacy is linked to better health behaviour (such as exercise and diet) and decreases in the progression of multiple disease processes including diabetes and cardiovascular disease ( Hladek et al., 2020 ). Individually tailored multifactorial interventions based on CGA (comprehensive geriatric assessment) was found to improve frailty status and physical function ( Lee et al., 2020 ). Improving patients’ self- efficacy and dispositional optimism might be the novel target of mindfulness-based cognitive therapy, peer-to-peer support, and group therapies, with the purpose of developing tailored psychological interventions in patients with chronic medical conditions ( Conversano et al., 2019 ). Frailty as a physically defined entity with psychosocial mediators is still understudied. Psychological components of physical frailty should not be ignored, and the challenge is to prioritize interventions. Therefore, the aim of this study was to evaluate the self-efficacy and optimism as possible psychological components in frail elderly. Methods Study setting The study participants were recruited from Geriatric outpatient clinic at Mansoura University Hospital, Mansoura, Egypt, in the period from August 2022 to March 2023. Study design and sampling This was a case-control study. The sample size was seventy (70) elderly male participants, aged sixty years and above. A sample size of 35 cases and 35 controls achieves a power of 80% to detect an effect size of 0.7 comparing the scores of GSES as well as LOT using two-sided z test with level of significance of 0.05 according to Nobutaka Doba et al. ( 2016 ). We used a Purposive random sampling. The study protocol was approved by Ain Shams University's Ethics Board. Each participant signed an informed written permission form. Data collection and assessment tools Participants were divided into 2 groups, A: frail elderly scored ≥ 3 using Avila modification of Fried criteria B: non frail (Robust elderly) are those scored 0. ( Avila-Funes et al., 2008 ) We Excluded: Female elderly, Prefrail elderly, participants who Refused to participate in the study, Patients with acute or chronic conditions interfering with initial assessment and/or communication (e.g., delirium), patients with functional disability “who need of assistance in at least one activity of daily living (Katz index) as defined by ( Marengoni et al., 2011 )”, Patients with dementia or depression. Each participant was subjected to: Comprehensive geriatric assessment: Proper history taking: A. Personal history including name, age, sex, occupation, special habits (smoking), education, marital status, caregiver, living, social event /loss, social activities/ leisure time, sleep problems, economic problems, and pain. B. Past Medical History including co-morbidities, medication history, history of dementia or depression. History of medications that could interfere with frailty (e.g., Statins, Aspocid, vitamin D, ACE inhibitors). Assessment of the nutritional status by using the Mini Nutritional Assessment tool (MNA) ( Guigoz et al., 1994 ) and the participants were divided into malnourished (less than 17), at risk of malnutrition (17-23.5) and well-nourished (24–30). Screening for cognitive impairment using the Arabic version ( El-Okl et al., 2002 ) of mini-mental state examination (MMSE) ( Folstein et al., 1975 ). matched for age and education ( Crum et al., 1993 ) Screening for depression: using the Arabic version ( Shehata et al., 1998 ) of geriatric depression scale (GDS) ( Sheikh and Yesavage, 1986 ) . A score of ≥ 5 suggests depression (Yesavage et al., 1982). Activities of Daily Living (ADL) (Katz et al., 1963) and Instrumental Activities of Daily Living (IADL) (Lawton et al., 1969) , patients were classified into independent, dependent, and assisted. Diagnosis of Physical Frailty: Frail participants were identified according to the Physical Frailty Phenotype (PFP ) ( Fried et al., 2001 ); using the modifications made by Avila-Funes ( Avila-Funes et al., 2008 ). The PFP includes five criteria: unintentional weight loss, slowness, weakness, low physical activity, and exhaustion. Avila- Funes has introduced a slightly different version of the original validated Fried frailty phenotype; the metrics used to characterize the frailty criteria were slightly different ( Avila-Funes et al., 2008 ). a. Weight loss: Participants who answered ‘‘yes’’ for recent and unintentional weight loss of ≥ 3 kg or, body mass index or had a body mass index, 21 kg/m2 were considered to be frail. b. Weakness: Participants answering ‘‘yes’’ to the following question were categorized as frail for this component: ‘‘Do you have difficulty rising from a chair?’’ c. Exhaustion: self-report exhaustion, identified by two questions: “I felt that everything I did was an effort’’ and ‘‘I could not get going.’’ Participants were asked: ‘‘How often, in the last week, did you feel this way?’’ 0 = rarely or none of the time; 1 = some or a little of the time; 2 = moderate amount of the time; or 3 = most of the time. Participants answering ‘‘2’’ or ‘‘3’’ to either of these questions were considered as frail by exhaustion. d. Slowness: The slowest quintile of the population was defined at baseline, based on a timed 6-meter walking test, adjusting for gender and height as recommended. 6m Walking speed more than 0.8m/ sec is considered frail by slowness. e. Low physical activity: A single response was used to estimate physical activity; Individuals who denied doing daily leisure activities such as walking or gardening and/or denied doing some sport activity per week were categorized as physically inactive. Those who reported doing them were physically active. Assessment of self-efficacy and optimism: Optimism was assessed using the Arabic version life orientation test (LOT) ( Scheier et al., 1994 ). The LOT-R is a self-reported measure that assess the participant’s expectancies regarding future outcomes that also relates to motivation. ten-items comprise a combination of direct scored, reverse-scored and filler items. Score Range of (0–13) reflects Low Optimism/ High Pessimism, (14–18): Moderate Optimism and (19–24): High Optimism. Self-efficacy was assessed using the Arabic version (Rudwan et al.,1997) of general efficacy scale (GES) (Schwarzer et al, 1995). This scale is a self-report measure of self-efficacy, which measures a participant’s confidence in their ability to respond to environmental demands and challenges. 10 items with a 4-point Likert response scale ranging from 1 (“not at all true”) to 4 (“exactly true”). the total score ranges between 10 and 40, with a higher score than 29 reflects high self-efficacy, score less than 29 reflects low self-efficacy. Statistical analysis The collected data were coded, tabulated, and statistically analysed using IBM SPSS statistics (Statistical Package for Social Sciences) software version 28.0, IBM Corp., Chicago, USA, 2021. Quantitative data tested for normality using Shapiro-Wilk test, then described as mean ± SD (standard deviation) as well as minimum and maximum of the range, and then compared using independent t-test (two independent groups) and ANOVA test (three independent groups). Qualitative data described as number and percentage and compared using Chi square test as well as Fisher’s Exact test for variables with small, expected numbers. Linear regression models were used to find out independent factors affecting certain conditions. ROC curve was used to evaluate the performance of different tests differentiate between certain subgroups. The level of significance was taken at p-value < 0.050 was significant, otherwise was non-significant. Diagnostic characteristics was calculated as follows: - Sensitivity = (True positive test / Total positive golden) x 100 - Specificity = (True negative test / Total negative golden) x 100 Results The study sample comprised seventy (70) elderly participants, men, sixty years and above, the mean age of the participants was 69 years (frail group),68 years (control group). The 2 groups were matched regarding demographic and socio-economic characteristics. BMI was significantly lower in frail group. Sleep problems, social inactivity, and high pain grades were significantly more frequent in frail group as shown in (table 1). MNA and IADL scores were significantly lower in the frail group. Malnutrition was significantly more frequent in the frail group. GDS score was significantly higher in the frail group (table 2). As regards comorbidities, DM was Significantly more frequent in the frail group. Comorbidities Numbers was significantly higher in the frail group (table 3). As regard medication, there was no significant difference regarding number of medications taken by both groups, but administration of Statin, ACEI and Aspocid were significantly less frequent in frail group (table 4). Self-efficacy as measured by SES and optimism as measured by R-LOT were significantly lower in the frail group, as shown in (Figs. 1&2). R-LOT and SES had significant moderate diagnostic performance in predicting frailty; their cutoff points had moderate sensitivity and low specificity as shown in table (5) & figure (3). There is positive correlation between self-efficacy and optimism; self-Efficacy was significantly lowest in cases with low Optimism as measured by R-LOT with no significant difference between moderate and high grades -Table (6). Table (1): Sociodemographic characteristics of the study groups Variables Frail group (Total = 35) Control group (Total = 35) p-value Age (years) Mean ± SD 69.1 ± 5.1 67.7 ± 4.0 ^0.195 Range 61.0–78.0 62.0–79.0 Education Illiterate 13 (37.1%) 13 (37.1%) #0.999 Illiterate 22 (62.9%) 22 (62.9%) Care giver Family 35 (100.0%) 33 (94.3%) § 0.493 Paid 0 (0.0%) 2 (5.7%) Marital status Married 28 (80.0%) 31 (88.6%) #0.324 Unmarried 7 (20.0%) 4 (11.4%) Living arrangement Alone 3 (8.6%) 4 (11.4%) § 0.999 With Spouse 32 (91.4%) 31 (88.6%) Presence of Social events in the last 6 months 14 (40.0%) 9 (25.7%) #0.203 Presence of Economic problems 25 (71.4%) 21 (60.0%) #0.314 Smoking None 9 (25.7%) 14 (40.0%) #0.203 Curent/Ex 26 (74.3%) 21 (60.0%) BMI (kg/m 2 ) Mean ± SD 19.4 ± 3.7 21.5 ± 2.8 ^0.010* Range 15.0–29.0 17.0–28.0 BMI categories Underweight 18 (51.4%) 5 (14.3%) #<0.001* Lean/over 17 (48.6%) 30 (85.7%) Sleep problems 28 (80.0%) 12 (34.3%) #<0.001* lack of social activities 25 (71.4%) 12 (34.3%) #0.002* Pain None 12 (34.3%) a 20 (57.1%) a #0.015* Mild 14 (40.0%) a 14 (40.0%) a Moderate 8 (25.7%) a 1 (2.9%) b ^Independent t-test. #Chi square test. §Fisher’s Exact test. *Significant Table (2): Comprehensive Geriatric Assessment (CGA) among the study groups Variables Frail group (Total = 35) Control group (Total = 35) p-value MNA Mean ± SD 20.9 ± 3.5 23.9 ± 3.0 ^<0.001* Range 15.0–26.0 16.0–28.0 Nutritional status Normal 11 (31.4%) 27 (77.1%) #<0.001* At risk/Mal. 24 (68.6%) 8 (22.9%) MMSE Mean ± SD 26.5 ± 2.2 27.1 ± 2.0 ^0.230 Range 19.0–30.0 19.0–30.0 GDS Mean ± SD 3.4 ± 0.8 1.6 ± 1.3 ^<0.001* Range 2.0–4.0 0.0–4.0 IADL Mean ± SD 4.7 ± 0.9 7.7 ± 0.7 ^<0.001* Range 3.0–6.0 6.0–8.0 ^Independent t-test. #Chi square test§ Fisher’s Exact test. *Significant MNA (mini nutritional assessment)- MMSE (mini-mental state examination)- GDS (geriatric depression score)- IADL (instrumental activity of daily living) Table (3): Comorbidities among the study groups Variables Frail group (Total = 35) Control group (Total = 35) p-value Comorbidities DM 20 (57.1%) 10 (28.6%) #0.016* Hypertension 16 (45.7%) 12 (34.3%) #0.329 IHD 14 (40.0%) 14 (40.0%) #0.999 Stroke 3 (8.6%) 1 (2.9%) § 0.614 CKD 6 (17.1%) 5 (14.3%) #0.743 CLD 16 (45.7%) 11 (31.4%) #0.220 COPD 10 (28.6%) 5 (14.3%) #0.145 Anemia 9 (25.7%) 6 (17.1%) #0.382 Thyroid 2 (5.7%) 2 (5.7%) #0.999 Comorbidities numbers Mean ± SD 2.7 ± 1.4 1.9 ± 1.1 ^0.004* Range 0.0–6.0 0.0–4.0 ^Independent t-test. #Chi square test. §Fisher’s Exact test. *Significant Table (4): Medication among the study groups Medications Statin 16 (45.7%) 25 (71.4%) #0.029* ACEI 12 (34.3%) 22 (62.9%) #0.017* Vitamin-D 13 (37.1%) 18 (51.4%) #0.229 Aspocid 12 (34.3%) 21 (60.0%) #0.031* Medications number Mean ± SD 5.1 ± 3.0 4.8 ± 1.8 ^0.563 Range 0.0–11.0 2.0–10.0 ^Independent t-test. #Chi square test. §Fisher’s Exact test. *Significant ACEI (angiotensin- converting enzyme inhibitor) Table (5): Diagnostic performance of R-LOT and SES in predicting frailty. Characteristics R-LOT SES AUC 0.755 0.714 SE 0.057 0.063 p-value < 0.001* 0.002* 95% CI 0.643–0.866 0.591–0.837 Cut point ≤ 17.0 ≤ 30.0 Sensitivity 88.6% 80.0% Specificity 51.4% 65.7% AUC: Area under curve. SE: Standard error. CI: Confidence interval, *significant Table (6): Comparison between cases with Low, moderate and high Optimism as measured by R-LOT regarding Self Efficacy Variables R-LOT p-value Low (Total = 22) Moderate (Total = 10) High (Total = 3) SES score 23.6 ± 5.5a 28.3 ± 1.8b 27.3 ± 2.9b ^0.031* SES categories Low 16 (72.7%) 7 (70.0%) 1 (33.3%) § 0.459 High 6 (27.3%) 3 (30.0%) 2 (66.7%) ^Independent t-test. §Fisher’s Exact test. Discussion In the study, health-related factors affecting the frailty of the subjects were derived from CGA of the patients participating in the study. Among factors that had a statistically significant effect on frailty, BMI was significantly lower in frail group (p-value < 0.001). Sleep problems(p-value < 0.001), lack of social activities (p-value = 0.002), and high pain grades(p-value = 0.015) significantly more frequent in frail group. The mean BMI among frail group was (19.4 ± 3.7) with under-weight (51.4%), this was agreed with Xu et al., 2020 , Wu et al., 2021 Au et al.,2021, Bichels et al.,2021. Rietman et al., 2018 . U-shaped association was observed between BMI and physical frailty; underweight as well as obesity is associated with physical frailty. Our results may be attributed to our sample gender being only males, compared to previous studies frail males and females were included. Higher overweight prevalence is observed more frequently among females, compared to higher underweight prevalence among frail males (Jayanama et al., 2022 ). Frail group reported high pain grades (65.7%) compared to control group (15%). This agreed with Pedro et al., 2019 , Yamada et al., 2018 , Chen et al., 2019 , who found that, there is an association between chronic pain and frailty in terms of prevalence. With higher prevalence among underweight frail males Yamada et al., 2018 , sleep problems Hiroya et al., 2022 and depression liu et al., 2021 . Chronic pain in frail elderly mediates sleep disorders and influences falls. Hiroya et al., 2022 . Sleep problems show higher prevalence among frail group (80%), compared to (34.3%) among controls, our study is consistent with, Pourmotabbed et al., 2020 , Lorber et al., 2023 and Madan et al., 2023. daytime drowsiness, sleep disordered breathing, and prolonged sleep latency enhanced the risk of frailty Pourmotabbed et al., 2020 . Higher sleep fragmentation index was associated with frailty and mortality. Greater wake after sleep onset and lower percent sleep were associated with mortality Guida et al., 2021 . As regards lack of social activities, it was more prevalent among frail group (71.4%), than control (34.3%). our study agreed with Davies et al., 2021 , Mehrabi et al., 2020 and Gale et al., 2018 , high levels of loneliness and social isolation were associated with an increased risk of becoming physically frail or pre-frail later especially in men. As regard comprehensive geriatric assessment, MNA and IADL were significantly lower in the frail group(p-value < 0.001). GDS score was significantly higher in the frail group. (p-value < 0.001) We found that malnutrition/ at risk was significantly more frequent in the frail group (68.6%), compared to control (22.9%), these findings agreed with Zhang et al., 2022 , O'Leary et al., 2020 , As regard IADL. frail elderlies were more dependent (IADL scores 4.6 ± 0.9) compared to control group (IADL scores 7.7 ± 0.7). our study agreed with a systematic review by Zamudio-Rodríguez et al., 2020 , Pérez-Ros et al., 2020 Kojima 2016 . Overall, frail older people were more likely to develop or worsen disabilities in ADL and IADL. Although in our study we excluded elderly with depression, frail elderly scored higher in GDS (3.4 ± 0.8) compared to lower GDS scores in control group (1.6 ± 1.3). Wang et al., 2023 , Buigues et al.,2015 Nascimento et al., 2016 concluded that depression is more prevalent among frail elderly with higher susceptibility among female, aged 75–79 years, with lower schooling and income, widow/widowers, higher number of disabilities and diseases, and those who met the criteria for frailty and pre-frailty. ( Woldesemayat et al., 2023 ) Co-morbidities Numbers was significantly higher in the frail group (2.7 ± 1.4) compared to (1.9 ± 1.1). DM was significantly more frequent in frail group (57.1%). We agreed with Vetrano et al., 2019, Hanlon et al., 2018 that there is a bidirectional association between multimorbidity and frailty. Most frail individuals are also multimorbid, but fewer multimorbid ones also present frailty. multimorbidity also increase the risk of mortality in frail patients. Hubbard et al., 2010 and Bundó et al., 2023 concluded that Frail older adults were 2.62 times more likely to have a complication of diabetes, independent of age, sex and number of years living with diabetes. Overall, there was no statistical difference regarding number of medications between frail (mean = 5.1 ± 3) and non-frail group (mean = 4.8 ± 1.8). Administration of Statin (45.7%in frails) (71.4% in controls), ACEI (34.3%in frails) (62.9% in controls) and Aspocid (34.3%in frails) (60% in controls) were significantly less frequent in frail group. Our study agreed with ÖZTÜRK et al., 2023 , Yoshimura et al., 2022 , Hanna et al., 2022 , that frail elderly take fewer protective medications. This could be due to financial burden, drugs adverse effect, care giver issues, advanced age, negative believes about usefulness of such medication in advanced age and its role in decreasing mortality/ morbidity. Mantelli et al., 2018 in a cross-sectional survey in Swiss GPs; 98% of GPs deprescribed at least one medication for no indication/ no added benefit if frail elderly, this including: aspirin, enalapril, amlodipine, and pantoprazole, atorvastatin, antidepressant and tramadol. Self-efficacy as measured by SES was25.3 ± 5 in frail group and 28.1 ± 4.6% in control group) and optimism as measured by R-LOT was 12.7 ± 3.3 in frail group and 16.6 ± 4.4 in control group. SES and R-LOT scores were significantly lower in the frail group, with positive correlation between R-LOT and SES scores. Self-Efficacy was significantly lowest in cases with low Optimism as measured by R-LOT with no significant difference between moderate and high grades. We explored the relationship between frailty and both self-efficacy and optimism as possible psychosocial determinants of physical frailty. Self-efficacy by definition” is an individual's belief in his or her capacity to execute behaviours necessary to produce specific performance attainments” ( Bandura, 1997 ). Self-efficacy represents confidence in the ability to exert control over one's own motivation, behaviour, and social environment. Enhancing self-efficacy can improve the outcomes and quality of life for patients living with chronic diseases ( Farley, 2019 ). As regard self-efficacy we concluded that there is negative corelation between self- efficacy and frailty. Our study agreed with Li et al., 2022 , Lin CH et al., 2022 , Hladek et al., 2020 Doba et al., 2016 . That frail elderly show low levels of self-efficacy; elderly with high coping self-efficacy is associated with lower odds of pre-frailty/frailty even with chronic disease. On the other hand, dispositional Optimism -by definition- is the generalized, relatively stable tendency to expect good outcomes across important life domains (Scheier et al., 2018). The relation between dispositional optimism and better adjustment to diverse stressors may be attributable to optimism's effects on coping strategies (Nes et al.,2006). there is negative corelation between dispositional optimism and frailty. Optimistic seniors cope better with aging/ life stressors, In Wang et al., 2022 study, optimism, resilience, higher levels of tenacity, strength were associated with lower prevalence of frailty. This agreed with Wang et al., 2022 , Kim & Won ,2022 Sardella et al., 2021 . Conclusion Our findings confirmed that, there is a relation between the general self-efficacy, optimism, and frailty. SES and R-LOT scales had moderate diagnostic accuracy in predicting frailty; thus, these scales could be used as part of comprehensive evaluation of frail elderly for psychosocial evaluation of frailty. Considering these findings, medical staff/geriatrician should pay closer attention Addressing psycho-social interventions of self-efficacy and optimism. This could add benefits to elderly in delaying the onset of frailty and/or protecting against adverse outcomes of physical frailty. This should be done side by side to other factors such as: nutrition, physical exercises, polypharmacy, depression, sleep, social isolation, and other novel interventions of frailty. Limitations of the study We acknowledge that there were some limitations to this study. It was limited by first, its narrow sample size. Second, this study used a case-control research design, which meant that the causal relationships between some study variables could not be identified accurately due to the presence of confounding factors. Further studies need to be conducted with larger sample size to identify factors affecting SES and R-LOT. Interventional psychological and behavioural studies need to be addressed to determine the possibility of protective effect of self- efficacy and optimism on frail elderly. Abbreviations GSES General Self Efficacy Scale R-LOT Revised- Life Orientation Test CGA Comprehensive Geriatric Assessment MNA Mini Nutritional Assessment MMSE Mini Mental State Examination GDS Geriatric Depression Scale ADL Activity of daily living IADL Instrumental activity of daily living PFP Physical Frailty Phenotype. Declarations Ethics approval and consent to participate. This study was approved by the Ethical Committee of Ain Shams University Hospitals (9/8/2022). All procedures were conducted within the ethical guidelines as outlined in the Declaration of Helsinki and its later amendments. All study participants were interviewed during clinic visits, confirm confidentiality, and obtain their informed written consent for participation. Consent for publication Not applicable Availability of data and material The datasets used and/or analysed during the current study are available. from the corresponding author on reasonable request. Competing interests The authors declare that they have no conflicts of interest to disclose. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' contributions D.A. was responsible for data collection and analysis, writing and editing; H.S. was responsible for revising data collection and revising the manuscript; N.H. was responsible for revising data collection, helped in the interpretation of data, formal analysis ,contributed in writing, revising the manuscript D.R. was responsible for the conceptualization and work design, contributed in writing, formal analysis of data, final revision of the manuscript ; H.H was responsible for revising the manuscript. All authors have approved the final manuscript. Acknowledgements The authors would like to thank all seniors who participated in the study for their time and effort. References Afek, A., Ben-Avraham, R., Davidov, A., Berezin Cohen, N., Ben Yehuda, A., Gilboa, Y., & Nahum, M. (2021). Psychological Resilience, Mental Health, and Inhibitory Control Among Youth and Young Adults Under Stress. Frontiers in psychiatry , 11 , 608588. https://doi.org/10.3389/fpsyt.2020.608588 Au PC, Li HL, Lee GK, Li GH, Chan M, Cheung BM, et al. (2021). Sarcopenia and mortality in cancer: A meta-analysis. Osteoporos Sarcopenia. 7(Supply 1), S28–33. https://doi.org/10.1016/j.afos.2021.03.002. Avila-Funes, J. A., Helmer, C., Amieva, H., Barberger-Gateau, P., Le Goff, M., Ritchie, K., Portet, F., Carrière, I., Tavernier, B., Gutiérrez-Robledo, L. M., & Dartigues, J. F. (2008). Frailty among community-dwelling elderly people in France: the three-city study. The journals of gerontology. Series A, Biological sciences and medical sciences , 63 (10), 1089–1096. https://doi.org/10.1093/gerona/63.10.1089 Bandura, A. (1997). Self-efficacy: The exercise of control. W H Freeman/Times Books/ Henry Holt & Co. Bichels AV, Cordeiro AC, Avesani CM, Amparo FC, Giglio J, Souza NC, et al. (2021). Muscle Mass Assessed by Computed Tomography at the Third Lumbar Vertebra Predicts Patient Survival in Chronic Kidney Disease. J Ren Nutr. 31(4),342–50. https://doi.org/10.1053/j.jrn.2020.05.007. Bundó, M., Vlacho, B., Llussà, J., Bobé, I., Aivar, M., Ciria, C., Martínez-Sánchez, A., Real, J., Mata-Cases, M., Cos, X., Dòria, M., Viade, J., Franch-Nadal, J., & Mauricio, D. (2023). Prediction of outcomes in subjects with type 2 diabetes and diabetic foot ulcers in Catalonian primary care centers: a multicenter observational study. Journal of foot and ankle research , 16 (1), 8. https://doi.org/10.1186/s13047-023-00602-6 Carver, C. S., & Scheier, M. F. (2014). Dispositional optimism. Trends in cognitive sciences , 18 (6), 293–299. https://doi.org/10.1016/j.tics.2014.02.003 Chen, C., Winterstein, A. G., Fillingim, R. B., & Wei, Y. J. (2019). Body weight, frailty, and chronic pain in older adults: a cross-sectional study. BMC geriatrics , 19 (1), 143. https://doi.org/10.1186/s12877-019-1149-4 Chesney, M. A., Neilands, T. B., Chambers, D. B., Taylor, J. M., & Folkman, S. (2006). A validity and reliability study of the coping self-efficacy scale. British journal of health psychology , 11 (Pt 3), 421–437. https://doi.org/10.1348/135910705X53155 Conversano, C., Poli, A., Ciacchini, R., Hitchcott, P., Bazzichi, L., & Gemignani, A. (2019). A psychoeducational intervention is a treatment for fibromyalgia syndrome. Clinical and experimental rheumatology , 37 Suppl 116 (1), 98–104. Cristina Buigues, Celia Padilla-Sánchez, Julio Fernández Garrido, Rut Navarro-Martínez, Vicente Ruiz-Ros & Omar Cauli (2015). The relationship between depression and frailty syndrome: a systematic review, Aging & Mental Health, 19:9, 762-772, DOI: 10.1080/13607863.2014.967174 Crum, R. M., Anthony, J. C., et al., (1993). Population- based norms for the Mini-Mental State Examination by age and educational level. Jama, 269(18), 2386-2391. Davide L Vetrano, MD and others (2019). Frailty and Multimorbidity: A Systematic Review and Meta-analysis, The Journals of Gerontology: Series A, Volume 74, Issue 5, Pages 659–666, https://doi.org/10.1093/gerona/gly110 Davies, K., Maharani, A., Chandola, T., Todd, C., & Pendleton, N. (2021). The longitudinal relationship between loneliness, social isolation, and frailty in older adults in England: a prospective analysis. The lancet. Healthy longevity , 2 (2), e70–e77. https://doi.org/10.1016/S2666-7568(20)30038-6 Del Corno, F., and Kiosses, D. N. (2018). The PDM-2 perspective on later life. Psychoanal. Psychol. 35, 346–350. Dent, E., Morley, J. E., Cruz-Jentoft, A. J., Woodhouse, L., Rodríguez-Mañas, L., Fried, L. P., Woo, J., Aprahamian, I., Sanford, A., Lundy, J., Landi, F., Beilby, J., Martin, F. C., Bauer, J. M., Ferrucci, L., Merchant, R. A., Dong, B., Arai, H., Hoogendijk, E. O., Won, C. W., … Vellas, B. (2019). Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. The journal of nutrition, health & aging , 23 (9), 771–787. https://doi.org/10.1007/s12603-019-1273-z Doba, N., Tokuda, Y., Saiki, K., Kushiro, T., Hirano, M., Matsubara, Y., & Hinohara, S. (2016). Assessment of Self-Efficacy and its Relationship with Frailty in the Elderly. Internal Medicine, 55(19), 2785–2792. https://doi.org/10.2169/internalmedicine.55.6924 doi: 10.1037/pap0000190 doi: 10.1186/s12916-022-02596-7. PMID: 36280863; PMCID: PMC9594976. Dos Santos, S. B., Rocha, G. P., Fernandez, L. L., de Padua, A. C., & Reppold, C. T. (2018). Association of Lower Spiritual Well-Being, Social Support, Self-Esteem, Subjective Well-Being, Optimism and Hope Scores With Mild Cognitive Impairment and Mild Dementia. Frontiers in psychology, 9, 371. https://doi.org/10.3389/fpsyg.2018.00371 El-Okl MA, Elbanoby MH, Eletrby MA, Mortagy AK and Elsaied MN (2002). Prevalence of Alzheimer dementia and other causes of dementia in Egyptian elderly. MD thesis, Faculty of Medicine, Ain Shams University. Geriatric Department Library. Farley H. (2019). Promoting self-efficacy in patients with chronic disease beyond traditional education: A literature review. Nursing open , 7 (1), 30–41. https://doi.org/10.1002/nop2.382 Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research , 12 (3), 189–198. https://doi.org/10.1016/0022-3956(75)90026-6 Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W. J., Burke, G., McBurnie, M. A., & Cardiovascular Health Study Collaborative Research Group (2001). Frailty in older adults: evidence for a phenotype. The journals of gerontology. Series A, Biological sciences and medical sciences , 56 (3), M146–M156. https://doi.org/10.1093/gerona/56.3.m146 Gaddey HL, Holder KK. (2021). Unintentional Weight Loss in Older Adults. Am Fam Physician. 104(1):34–40. Gale, C. R., Westbury, L., & Cooper, C. (2018). Social isolation and loneliness as risk factors for the progression of frailty: the English Longitudinal Study of Ageing. Age and ageing , 47 (3), 392–397. https://doi.org/10.1093/ageing/afx188 Gobbens, R. J. J., & Andreasen, J. (2020). The prediction of readmission and mortality by the domains and components of the Tilburg Frailty Indicator (TFI): A prospective cohort study among acutely admitted older patients. Archives of gerontology and geriatrics , 89 , 104077. https://doi.org/10.1016/j.archger.2020.104077 Gobbens, R. J., van Assen, M. A., Augustijn, H., Goumans, M., & van der Ploeg, T. (2021). Prediction of mortality by the Tilburg Frailty Indicator (TFI). Journal of the American Medical Directors Association , 22 (3), 607-e1. https://doi.org/10.1016/j.jamda.2020.07.033 Guida, J. L., Alfini, A. J., Gallicchio, L., Spira, A. P., Caporaso, N. E., & Green, P. A. (2021). Association of objectively measured sleep with frailty and 5-year mortality in community-dwelling older adults. Sleep , 44 (7), zsab003. https://doi.org/10.1093/sleep/zsab003 Guigoz, Y., Vellas, B. and Garry, P.J. (1994). Mini Nutritional Assessment: A practical Assessment Tool for Grading the Nutritional State of Elderly Patients. In: Vellas, B., Ed., The Mini Nutritional Assessment (MNA), Supplement No 2, Serdi Publisher, Paris, 15-59. Hanna, V., Chahine, B., & Al Souheil, F. (2022). Under-prescription of medications in older adults according to START criteria: A cross-sectional study in Lebanon. Health science reports , 5 (5), e759. https://doi.org/10.1002/hsr2.759 Hiroya Honda, Ryota Ashizawa, Kazuya Kiriyama, Koki Take, Tatsuya Hirase, Shinichi Arizono, Yoshinobu Yoshimoto (2022). Chronic pain in the frail elderly mediates sleep disorders and influences falls, Archives of Gerontology and Geriatrics, Volume 99, 104582, ISSN 0167-4943, https://doi.org/10.1016/j.archger.2021.104582. Hladek, M. D., Gill, J., Bandeen-Roche, K., Walston, J. D., Allen, J. K., Hinkle, J. L., Lorig, K., & Szanton, S. L. (2020). High coping self-efficacy associated with lower odds of pre-frailty/frailty in older adults with chronic disease. Aging & Mental Health, 24(12), 1956–1962. https://doi.org/10.1080/13607863.2019.1639136 Hladek, M. D., Gill, J., Bandeen-Roche, K., Walston, J., Allen, J., Hinkle, J. L., Lorig, K., & Szanton, S. L. (2020). High coping self-efficacy associated with lower odds of pre-frailty/frailty in older adults with chronic disease. Aging & mental health, 24(12), 1956–1962. https://doi.org/10.1080/13607863.2019.1639136 Hoogendijk, E. O., Afilalo, J., Ensrud, K. E., Kowal, P., Onder, G., & Fried, L. P. (2019). Frailty: implications for clinical practice and public health. The Lancet , 394 (10206), 1365–1375. https://doi.org/10.1016/s0140-6736(19)31786-6 Howlett, S. E., Rutenberg, A. D., & Rockwood, K. (2021). The degree of frailty as a translational measure of health in aging. Nature aging , 1 (8), 651–665. https://doi.org/10.1038/s43587-021-00099-3 Hubbard, R.E., Andrew, M.K., Fallah, N. and Rockwood, K. (2010). Comparison of the prognostic importance of diagnosed diabetes, co-morbidity and frailty in older people. Diabetic Medicine, 27: 603-606. https://doi.org/10.1111/j.1464-5491.2010.02977.x Jang, I. Y., Jung, H. W., Park, H., Lee, C. K., Yu, S. S., Lee, Y. S., Lee, E., Glynn, R. J., & Kim, D. H. (2018). A multicomponent frailty intervention for socioeconomically vulnerable older adults: a designed-delay study. Clinical interventions in aging , 13 , 1799–1814. https://doi.org/10.2147/CIA.S177018 Jayanama K, Theou O, Godin J, Mayo A, Cahill L, Rockwood K. (2022). Relationship of body mass index with frailty and all-cause mortality among middle-aged and older adults. BMC Med. 24;20(1):404. Jerome A. Yesavage, T.L. Brink, Terence L. Rose, Owen Lum, Virginia Huang, Michael Adey, Von Otto Leirer (1982). Development and validation of a geriatric depression screening scale: A preliminary report, Journal of Psychiatric Research, Volume 17, Issue 1, 37-49, ISSN 0022-3956, https://doi.org/10.1016/0022-3956(82)90033-4. Joseph, B., Saljuqi, A. T., Amos, J. D., Teichman, A., Whitmill, M. L., Anand, T., Hosseinpour, H., Burruss, S. K., Dunn, J. A., Najafi, K., Godat, L. N., Enniss, T. M., Shoultz, T. H., Egodage, T., Bongiovanni, T., Hazelton, J. P., Colling, K. P., Costantini, T. W., Stein, D. M., Schroeppel, T. J., … AAST Frailty MIT Study Group (2023). Prospective validation and application of the Trauma-Specific Frailty Index: Results of an American Association for the Surgery of Trauma multi-institutional observational trial. The journal of trauma and acute care surgery , 94 (1), 36–44. https://doi.org/10.1097/TA.0000000000003817 KATZ, S., FORD, A. B., MOSKOWITZ, R. W., JACKSON, B. A., & JAFFE, M. W. (1963). STUDIES OF ILLNESS IN THE AGED. THE INDEX OF ADL: A STANDARDIZED MEASURE OF BIOLOGICAL AND PSYCHOSOCIAL FUNCTION. JAMA , 185 , 914–919. https://doi.org/10.1001/jama.1963.03060120024016 Kim, S., & Won, C. W. (2022). Optimistic orientation and frailty in community-dwelling older adults: Results from KFACS study. Experimental Gerontology , 170 , 111963. https://doi.org/10.1016/j.exger.2022.111963 Koga, HK, Trudel-Fitzgerald, C, Lee, LO, et al. (2022). Optimism, lifestyle, and longevity in a racially diverse cohort of women. J Am Geriatr Soc . 70(10): 2793- 2804. doi:10.1111/jgs.17897 Kojima, G. (2016). Frailty as a predictor of disabilities among community-dwelling older people: a systematic review and meta-analysis. Disability and Rehabilitation , 39 (19), 1897–1908. https://doi.org/10.1080/09638288.2016.1212282 Lawton MP, Brody EM (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist; 9(3): 179–186. Lee H, Lee E, Jang IY. (2020). Frailty and Comprehensive Geriatric Assessment. J Korean Med Sci. 35(3): e16. https://doi.org/10.3346/jkms.2020.35.e16 Li X, Yang K, An Y, Liu M, Yan C, Huang R. (2022). General self-efficacy and frailty in hospitalized older patients: The mediating effect of loneliness. Geriatr Nursing. 48:315-319. doi: 10.1016/j.gerinurse.2022.10.019. Epub 2022 Nov 7. PMID: 36356532. Lin CH, Liu CY, Huang CC, Rong JR. (2022). Frailty and Quality of Life among Older Adults in Communities: The Mediation Effects of Daily Physical Activity and Healthy Life Self-Efficacy. Geriatrics (Basel) .7(6):125. doi: 10.3390/geriatrics7060125. PMID: 36412614; PMCID: PMC9680389. Liu M, Hou T, Nkimbeng M, Li Y, Taylor JL, Sun X, Tang S, Szanton SL. (2021). Associations between symptoms of pain, insomnia and depression, and frailty in older adults: A cross-sectional analysis of a cohort study. Int J Nurs Stud. 117:103873. doi: 10.1016/j.ijnurstu.2021.103873. Epub 2021 Jan 12. PMID: 33621722; PMCID: PMC9940903. Lorber, M., Kmetec, S., Davey, A., Mlinar Reljić, N., Fekonja, Z., & Kegl, B. (2023). Associations between Sleep Quality, Frailty, and Quality of Life among Older Adults in Community and Nursing Home Settings. International journal of environmental research and public health , 20 (6), 4937. https://doi.org/10.3390/ijerph20064937 Lorenzo-López, L., Maseda, A., de Labra, C. et al. (2017). Nutritional determinants of frailty in older adults: A systematic review. BMC Geriatric 17, 108. https://doi.org/10.1186/s12877-017-0496-2 Madan Jha V. (2022). The prevalence of sleep loss and sleep disorders in young and old adults. Aging brain , 3 , 100057. https://doi.org/10.1016/j.nbas.2022.100057 Mantelli, S., Jungo, K.T., Rozsnyai, Z. et al. (2018). How general practitioners would deprescribe in frail oldest-old with polypharmacy — the LESS study. BMC Fam Pract 19, 169 https://doi.org/10.1186/s12875-018-0856-9 Marengoni, A., Angleman, S., & Fratiglioni, L. (2011). Prevalence of disability according to multimorbidity and disease clustering: a population-based study. Journal of comorbidity , 1 , 11–18.https://doi.org/10.15256/joc.2011.1.3 Mehrabi, F., & Béland, F. (2020). Effects of social isolation, loneliness and frailty on health outcomes and their possible mediators and moderators in community-dwelling older adults: A scoping review. Archives of gerontology and geriatrics , 90 , 104119. https://doi.org/10.1016/j.archger.2020.104119 Melissa D. Hladek, Jessica Gill, Karen Bandeen-Roche, Jeremy Walston, Jerilyn Allen, Janice L. Hinkle, Kate Lorig & Sarah L. Szanton (2019). High coping self-efficacy associated with lower odds of pre-frailty/frailty in older adults with chronic disease, Aging & Mental Health, DOI: 10.1080/13607863.2019.1639136 Morley J. E. (2017). The New Geriatric Giants. Clinics in geriatric medicine , 33 (3), xi–xii. https://doi.org/10.1016/j.cger.2017.05.001 Nascimento, P. P. P., Batistoni, S. S. T., & Neri, A. L. (2016). Frailty and depressive symptoms in older adults: data from the FIBRA study - UNICAMP. Psicologia: Reflexão E Crítica, 29. https://doi.org/10.1186/s41155-016-0033-9 Nes, L. S., & Segerstrom, S. C. (2006). Dispositional optimism and coping: a meta-analytic review. Personality and social psychology review: an official journal of the Society for Personality and Social Psychology, Inc , 10 (3), 235–251. https://doi.org/10.1207/s15327957pspr1003_3 Nieves-Lugo, K., Ware, D., Althoff, K., Brennan-Ing, M., Meanley, S., Brown, A. L., Haberlen, S. A., Masters, M., Egan, J. E., Friedman, M. R., & Plankey, M. (2021). Negative Perception of Aging Is Associated With Frailty Transitions Within a Cohort of Sexual Minority Men. Innovation in aging , 5 (4), igab035. https://doi.org/10.1093/geroni/igab035 O'Leary, M. F., Barreto, M., & Bowtell, J. L. (2020). Evaluating the Effect of a Home-Delivered Meals Service on the Physical and Psychological Wellbeing of a UK Population of Older Adults - A Pilot and Feasibility Study. Journal of nutrition in gerontology and geriatrics, 39(1), 1–15. https://doi.org/10.1080/21551197.2019.1684417 Öztürk, E., Ganidagli, S., & Öztürk, Z. A. (2023). Polypharmacy in the Elderly: A Double-Edged Sword. Medical Records-international Medical Journal , 5 (2), 255–261. https://doi.org/10.37990/medr.1183707 Pedro Otones Reyes, Eva García Perea, Azucena Pedraz Marcos (2019). Chronic Pain and Frailty in Community-Dwelling Older Adults: A Systematic Review, Pain Management Nursing, Volume 20, Issue 4,2019, Pages 309-315, ISSN 1524-9042. https://doi.org/10.1016/j.pmn.2019.01.003. Pérez-Ros P, Vila-Candel R, López-Hernández L, Martínez-Arnau FM. (2020). Nutritional Status and Risk Factors for Frailty in Community-Dwelling Older People: A Cross-Sectional Study. Nutrients.10;12(4):1041. doi: 10.3390/nu12041041. PMID: 32290060; PMCID: PMC7231056. Peter Hanlon, Barbara I Nicholl, Bhautesh Dinesh Jani, Duncan Lee, Ross McQueenie, Frances S Mair (2018). Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality: a prospective analysis of 493 737 UK Biobank participants,The Lancet Public Health,Volume 3, Issue 7, Pages e323-e332,ISSN 2468-2667, https://doi.org/10.1016/S2468-2667(18)30091-4. Pourmotabbed, A., Boozari, B., Babaei, A. et al. (2020). Sleep and frailty risk: a systematic review and meta-analysis. Sleep Breath 24, 1187–1197. https://doi.org/10.1007/s11325-020-02061-w Rietman, M. L., van der A, D. L., van Oostrom, S. H., Picavet, H. S. J., Dollé, M. E. T., van Steeg, H., Verschuren, W. M. M., & Spijkerman, A. M. W. (2018). The Association between BMI and Different Frailty Domains: A U-Shaped Curve?. The journal of nutrition, health & aging , 22 (1), 8–15. https://doi.org/10.1007/s12603-016-0854-3 Rudwan, S.J (1997). Expectations of self-efficacy "theoretical construction and measurement". Social Affairs Collection, Sharjah ;14(55):25-51. Sardella, A., Lenzo, V., Alibrandi, A., Catalano, A., Corica, F., Quattropani, M. C., & Basile, G. (2021). A Clinical Bridge between Family Caregivers and Older Adults: The Contribution of Patients' Frailty and Optimism on Caregiver Burden. International journal of environmental research and public health , 18 (7), 3406. https://doi.org/10.3390/ijerph18073406 Scheier, M. F., & Carver, C. S. (2018). Dispositional optimism and physical health: A long look back, a quick look forward. American Psychologist, 73(9), 1082–1094. https://doi.org/10.1037/amp0000384 Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test. Journal of personality and social psychology , 67 (6), 1063–1078. https://doi.org/10.1037//0022-3514.67.6.1063 Schoufour, J. D., Mitnitski, A., Rockwood, K., Evenhuis, H. M., & Echteld, M. A. (2013). Development of a frailty index for older people with intellectual disabilities: results from the HA-ID study. Research in developmental disabilities , 34 (5), 1541–1555. https://doi.org/10.1016/j.ridd.2013.01.029 Schwarzer, R., & Jerusalem, M. (1995) . Generalized Self-Efficacy scale. In J. Weinman, S. Wright, & M. Johnston, Measures in health psychology: A user’s portfolio. Causal and control beliefs (pp. 35-37). Windsor, UK: NFER-NELSON. Schwarzer, Ralf & Jerusalem, Matthias. (2010). The general self-efficacy scale (GSE). Anxiety, Stress, and Coping. 12. 329-345. Shehata AS, Elbanoby MH, Mortagy AK and Ghanem M (1998). Prevalence of depression among Egyptian Geriatric Community. Ain Shams University. Geriatric Department Library. Sheikh JA and Yesavage YA (1986). Geriatric Depression Scale. Recent evidence and development of a shorter version. Clinical Gerontology: A Guide to Assessment and Intervention; 165-173, NY: The Haworth Press. Sugie, M., Harada, K., Nara, M., Kugimiya, Y., Takahashi, T., Kitagou, M., . . . Ito, H. (2022). Prevalence, overlap, and interrelationships of physical, cognitive, psychological, and social frailty among community-dwelling older people in Japan. Archives of Gerontology and Geriatrics, 100, 104659. https://doi.org/10.1016/j.archger.2022.104659 Taylor, M. G., & Carr, D. (2021). Psychological Resilience and Health Among Older Adults: A Comparison of Personal Resources. The journals of gerontology. Series B, Psychological sciences and social sciences , 76 (6), 1241–1250. https://doi.org/10.1093/geronb/gbaa116 Wang, Q., Song, D., Lin, Q., Tao, A., Zhang, Y., Li, X., & Qiu, X. (2023). The critical role of physical frailty and function on depressive symptoms among community-dwelling older adults in China: A cross-sectional study. Frontiers in psychiatry , 14 , 1134427. https://doi.org/10.3389/fpsyt.2023.1134427 Wang, Y., Chen, Y., Xu, J., Chen, H., & Gao, J. (2022). Association between resilience and frailty among Chinese older adults. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.948958 Woldesemayat, E. M., St Clair-Sullivan, N., Kassa, A., Gari, T., Gutema, K., Chea, N., Woubshet, K., Bogale, N., Assefa, A., & Vera, J. (2023). Frailty status and associated factors among older PLHIV in Southern Ethiopia. PloS one , 18 (4), e0284376. https://doi.org/10.1371/journal.pone.0284376 Wu, L. C., Kao, H. H., Chen, H. J., & Huang, P. F. (2021). Preliminary screening for sarcopenia and related risk factors among the elderly. Medicine , 100 (19), e25946. https://doi.org/10.1097/MD.0000000000025946 Xu, L., Zhang, J., Shen, S., Hong, X., Zeng, X., Yang, Y., Liu, Z., Chen, L., & Chen, X. (2020). Association Between Body Composition and Frailty in Elder Inpatients. Clinical interventions in aging , 15 , 313–320. https://doi.org/10.2147/CIA.S243211 Yamada, K., Kubota, Y., Iso, H., Oka, H., Katsuhira, J., & Matsudaira, K. (2018). Association of body mass index with chronic pain prevalence: a large population-based cross-sectional study in Japan. Journal of anesthesia , 32 (3), 360–367. https://doi.org/10.1007/s00540-018-2486-8 Yoshimura, Y., Matsumoto, A., & Momosaki, R. (2022). Pharmacotherapy and the Role of Pharmacists in Rehabilitation Medicine. Progress in rehabilitation medicine , 7 , 20220025. https://doi.org/10.2490/prm.20220025 Zamudio-Rodríguez, A., Letenneur, L., Féart, C., Avila-Funes, J. A., Amieva, H., & Pérès, K. (2020). The disability process: is there a place for frailty?. Age and ageing , 49 (5), 764–770. https://doi.org/10.1093/ageing/afaa031 Zhang, Q., Yu, S., Li, Q., Zhang, M., Meng, L., & Hu, S. (2022). Preoperative Nutritional Status in Elderly Inpatients with Gastrointestinal Cancer and Its Linear Association with Frailty. Nutrition and cancer , 74 (4), 1376–1387. https://doi.org/10.1080/01635581.2021.1955284 Zhao, J., Liu, J. Y. W., Tyrovolas, S., & Mutz, J. (2023). Exploring the concept of psychological frailty in older adults: a systematic scoping review. Journal of Clinical Epidemiology . https://doi.org/10.1016/j.jclinepi.2023.05.005 Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3244949","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":224879361,"identity":"6127b878-02a6-4c56-8ae5-c4eeed0d7b8f","order_by":0,"name":"Doaa Ageez","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABC0lEQVRIiWNgGAWjYDCCAzAGM/PBxz8qINwDD4jSws6WbMxw5gADD0gwgSgt/Dxm0oxtEC0M+LTwHW9++OHHLxs5+WaglsJ5d+TsxQ4/BNpiJ6fbgF2L5JljxpK9fWnGjM1sxdYztz0z5pFOMwBqSTY2O4Bdi8GNBAMJ3p7Dic3MzBtv8G47nNgjnQDSciBxG04t6Z9//u35X9/GzADUOwekJf0DAS05ZtI8Pw4k8DCzGEnzNoC05OC3RfLMmTJr2YZkwxnMbEDi2GFjnts5BQcSDHD7he94++abb/7Yycv3Hz744EPNYTn22embP3yosJPDpQUMGNswHYxHORj8IaRgFIyCUTAKRjQAAIndZ+WI1sdbAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0009-0005-6683-3894","institution":"Ain Shams university","correspondingAuthor":true,"prefix":"","firstName":"Doaa","middleName":"","lastName":"Ageez","suffix":""}],"badges":[],"createdAt":"2023-08-08 09:51:19","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":true,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false,"coiExplicitlySet":false},"doi":"10.21203/rs.3.rs-3244949/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3244949/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":41317565,"identity":"c7b281d2-028d-4ec3-ab5d-bbb61f028e0e","added_by":"auto","created_at":"2023-08-09 15:36:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":56495,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOptimism among the study groups\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3244949/v1/339887b2c7d4489fd1c366b4.png"},{"id":41318392,"identity":"b5fe7103-71e6-4928-8a1e-c3d8f79e3748","added_by":"auto","created_at":"2023-08-09 15:44:38","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":55561,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSelf-efficacy among the study groups\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-3244949/v1/1f16a046071a2bfdf914073c.png"},{"id":41317567,"identity":"620b5c4f-f3ce-4762-99ae-8138b1929f02","added_by":"auto","created_at":"2023-08-09 15:36:38","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":38168,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eReceiver operating characteristics (ROC) curve for R-LOT and SES in predicting frailty.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-3244949/v1/52240a1dd50bd05e11f83973.png"},{"id":41318415,"identity":"66567e7b-8a4d-4ca3-87b0-c7740881a87f","added_by":"auto","created_at":"2023-08-09 15:44:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":893219,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3244949/v1/d406a130-b2b2-4c76-9166-9c691c6cdb0a.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003e\u003cstrong\u003eSelf-efficacy and Optimism in frail elderly men without functional disability attending geriatric outpatient clinic in Mansoura university: a case-control study.\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eFrailty is an emerging international health burden, with major implications for clinical practice and public health. The prevalence of frailty is exponentially rising alongside with rapid growth in the ageing population \u003cb\u003e(\u003c/b\u003eHoogendijk et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). \u0026ldquo;Frailty\u0026rdquo; is a state of loss of resilience and enhanced vulnerability to stressors \u003cb\u003e(\u003c/b\u003eJoseph et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), which leads to adverse outcomes such as falls, dependence, hospitalization, institutionalization, and death \u003cb\u003e(\u003c/b\u003eHowlett et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Frailty as a broad term has multidimensional nature of the deficit accumulation. The biopsychosocial model of frailty explains frailty as a multidimensional condition including physical, cognitive, social, and psychological domains \u003cb\u003e(Morley,2017).\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePsychological frailty is a complex concept with multiple components. It should include both mental features and physical frailty. \u003cb\u003eJinlong Zhao and his colleagues\u003c/b\u003e identified a set of components that were most frequently used to capture the scope of psychological frailty: mood problems, cognitive problems, mental health problems and fatigue associated problems \u003cb\u003e(\u003c/b\u003eZhao et al., \u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePsychological resilience refers to \u0026ldquo;the capacity of an individual to cope in the face of stressors and adversity, allowing individuals to successfully maintain their physical and mental health\u0026rdquo; \u003cb\u003e(\u003c/b\u003eAfek et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Dispositional optimism is commonly recognized as a psychological factor able to promote resilience and to promote a positive adaptation to aging \u003cb\u003e(\u003c/b\u003eTaylor \u0026amp; Carr, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e2021\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e Optimism as a cognitive construct is \u0026ldquo;the positive expectations regarding future outcomes, which is related to motivation\u0026rdquo; \u003cb\u003e(Carver et al., 2014)\u003c/b\u003e. Koga and her colleagues showed that higher levels of optimism were associated with greater probability of achieving exceptional longevity \u003cb\u003e(Koga et al.,2022\u003c/b\u003e, as optimistic people are encouraged to embrace healthy lifestyle, such as engaging in physical activity, healthy diet, and cessation of smoking (Dos Santos et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSelf-efficacy is defined as \u0026ldquo;confidence to perform a specific behaviour or succeed in a specific life domain, which is attained through four distinct mechanisms: personal mastery, physiologic feedback, verbal persuasion, and vicarious experience\u0026rdquo; \u003cb\u003e(\u003c/b\u003eBandura, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e1997\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e Coping self-efficacy is a domain-specific concept of confidence to cope effectively with difficulties in the areas of problem solving, emotional regulation and obtaining support from one\u0026rsquo;s social network \u003cb\u003e(\u003c/b\u003eChesney et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). This is especially important in addressing \u0026ldquo;frailty identity crisis\u0026rdquo; along the life course of frail elderly, thus influence easy transitioning and alleviate unpleasant drawbacks \u003cb\u003e(\u003c/b\u003eLi et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Self-efficacy is malleable and was successfully targeted in health-related interventions, making it a potentially useful intervention goal for the treatment of frailty. Increase in self-efficacy is linked to better health behaviour (such as exercise and diet) and decreases in the progression of multiple disease processes including diabetes and cardiovascular disease \u003cb\u003e(\u003c/b\u003eHladek et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIndividually tailored multifactorial interventions based on CGA (comprehensive geriatric assessment) was found to improve frailty status and physical function \u003cb\u003e(\u003c/b\u003eLee et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Improving patients\u0026rsquo; self- efficacy and dispositional optimism might be the novel target of mindfulness-based cognitive therapy, peer-to-peer support, and group therapies, with the purpose of developing tailored psychological interventions in patients with chronic medical conditions \u003cb\u003e(\u003c/b\u003eConversano et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFrailty as a physically defined entity with psychosocial mediators is still understudied. Psychological components of physical frailty should not be ignored, and the challenge is to prioritize interventions. Therefore, the aim of this study was to evaluate the self-efficacy and optimism as possible psychological components in frail elderly.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy setting\u003c/h2\u003e\n \u003cp\u003eThe study participants were recruited from Geriatric outpatient clinic at Mansoura University Hospital, Mansoura, Egypt, in the period from August 2022 to March 2023.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy design and sampling\u003c/h2\u003e\n \u003cp\u003eThis was a case-control study. The sample size was seventy (70) elderly male participants, aged sixty years and above. A sample size of 35 cases and 35 controls achieves a power of 80% to detect an effect size of 0.7 comparing the scores of GSES as well as LOT using two-sided z test with level of significance of 0.05 according to \u003cstrong\u003eNobutaka\u003c/strong\u003e Doba et al. (\u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e). We used a Purposive random sampling. The study protocol was approved by Ain Shams University\u0026apos;s Ethics Board. Each participant signed an informed written permission form.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eData collection and assessment tools\u003c/h2\u003e\n \u003cp\u003eParticipants were divided into 2 groups, A: frail elderly scored\u0026thinsp;\u0026ge;\u0026thinsp;3 using Avila modification of Fried criteria B: non frail (Robust elderly) are those scored 0. \u003cstrong\u003e(\u003c/strong\u003eAvila-Funes et al., \u003cspan class=\"CitationRef\"\u003e2008\u003c/span\u003e)\u003c/p\u003e\n \u003cp\u003eWe Excluded: Female elderly, Prefrail elderly, participants who Refused to participate in the study, Patients with acute or chronic conditions interfering with initial assessment and/or communication (e.g., delirium), patients with functional disability \u0026ldquo;who need of assistance in at least one activity of daily living (Katz index) as defined by \u003cstrong\u003e(\u003c/strong\u003eMarengoni et al., \u003cspan class=\"CitationRef\"\u003e2011\u003c/span\u003e)\u0026rdquo;, Patients with dementia or depression.\u003c/p\u003e\n \u003cp\u003eEach participant was subjected to:\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eComprehensive geriatric assessment:\u003c/h2\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eProper history taking: A. Personal history including name, age, sex, occupation, special habits (smoking), education, marital status, caregiver, living, social event /loss, social activities/ leisure time, sleep problems, economic problems, and pain. B. Past Medical History including co-morbidities, medication history, history of dementia or depression. History of medications that could interfere with frailty (e.g., Statins, Aspocid, vitamin D, ACE inhibitors).\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eAssessment of the nutritional status by using the Mini Nutritional Assessment tool (MNA) \u003cstrong\u003e(\u003c/strong\u003eGuigoz et al., \u003cspan class=\"CitationRef\"\u003e1994\u003c/span\u003e) and the participants were divided into malnourished (less than 17), at risk of malnutrition (17-23.5) and well-nourished (24\u0026ndash;30).\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eScreening for cognitive impairment using the Arabic version \u003cstrong\u003e(\u003c/strong\u003eEl-Okl et al., \u003cspan class=\"CitationRef\"\u003e2002\u003c/span\u003e) of mini-mental state examination (MMSE) \u003cstrong\u003e(\u003c/strong\u003eFolstein et al., \u003cspan class=\"CitationRef\"\u003e1975\u003c/span\u003e). matched for age and education \u003cstrong\u003e(\u003c/strong\u003eCrum et al., \u003cspan class=\"CitationRef\"\u003e1993\u003c/span\u003e)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eScreening for depression: using the Arabic version \u003cstrong\u003e(\u003c/strong\u003eShehata et al., \u003cspan class=\"CitationRef\"\u003e1998\u003c/span\u003e) of geriatric depression scale (GDS) \u003cstrong\u003e(\u003c/strong\u003eSheikh and Yesavage, \u003cspan class=\"CitationRef\"\u003e1986\u003c/span\u003e\u003cstrong\u003e)\u003c/strong\u003e. A score of \u0026ge;\u0026thinsp;5 suggests depression \u003cstrong\u003e(Yesavage et al., 1982).\u003c/strong\u003e\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eActivities of Daily Living (ADL) \u003cstrong\u003e(Katz et al., 1963)\u003c/strong\u003e and Instrumental Activities of Daily Living (IADL) \u003cstrong\u003e(Lawton et al., 1969)\u003c/strong\u003e, patients were classified into independent, dependent, and assisted.\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eDiagnosis of Physical Frailty:\u003c/h2\u003e\n \u003cp\u003eFrail participants were identified according to the Physical Frailty Phenotype (PFP\u003cstrong\u003e) (\u003c/strong\u003eFried et al., \u003cspan class=\"CitationRef\"\u003e2001\u003c/span\u003e); using the modifications made by Avila-Funes \u003cstrong\u003e(\u003c/strong\u003eAvila-Funes et al., \u003cspan class=\"CitationRef\"\u003e2008\u003c/span\u003e). The PFP includes five criteria: unintentional weight loss, slowness, weakness, low physical activity, and exhaustion. Avila- Funes has introduced a slightly different version of the original validated Fried frailty phenotype; the metrics used to characterize the frailty criteria were slightly different \u003cstrong\u003e(\u003c/strong\u003eAvila-Funes et al., \u003cspan class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003ea. Weight loss: Participants who answered \u0026lsquo;\u0026lsquo;yes\u0026rsquo;\u0026rsquo; for recent and unintentional weight loss of \u0026ge;\u0026thinsp;3 kg or, body mass index or had a body mass index, 21 kg/m2 were considered to be frail.\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003eb. Weakness: Participants answering \u0026lsquo;\u0026lsquo;yes\u0026rsquo;\u0026rsquo; to the following question were categorized as frail for this component: \u0026lsquo;\u0026lsquo;Do you have difficulty rising from a chair?\u0026rsquo;\u0026rsquo;\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003ec. Exhaustion: self-report exhaustion, identified by two questions: \u0026ldquo;I felt that everything I did was an effort\u0026rsquo;\u0026rsquo; and \u0026lsquo;\u0026lsquo;I could not get going.\u0026rsquo;\u0026rsquo; Participants were asked: \u0026lsquo;\u0026lsquo;How often, in the last week, did you feel this way?\u0026rsquo;\u0026rsquo; 0\u0026thinsp;=\u0026thinsp;rarely or none of the time; 1\u0026thinsp;=\u0026thinsp;some or a little of the time; 2\u0026thinsp;=\u0026thinsp;moderate amount of the time; or 3\u0026thinsp;=\u0026thinsp;most of the time. Participants answering \u0026lsquo;\u0026lsquo;2\u0026rsquo;\u0026rsquo; or \u0026lsquo;\u0026lsquo;3\u0026rsquo;\u0026rsquo; to either of these questions were considered as frail by exhaustion.\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003ed. Slowness: The slowest quintile of the population was defined at baseline, based on a timed 6-meter walking test, adjusting for gender and height as recommended. 6m Walking speed more than 0.8m/ sec is considered frail by slowness.\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003ee. Low physical activity: A single response was used to estimate physical activity; Individuals who denied doing daily leisure activities such as walking or gardening and/or denied doing some sport activity per week were categorized as physically inactive. Those who reported doing them were physically active.\u003cbr\u003e\u003c/span\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eAssessment of self-efficacy and optimism:\u003c/h2\u003e\n \u003cp\u003eOptimism was assessed using the Arabic version life orientation test (LOT) \u003cstrong\u003e(\u003c/strong\u003eScheier et al., \u003cspan class=\"CitationRef\"\u003e1994\u003c/span\u003e). The LOT-R is a self-reported measure that assess the participant\u0026rsquo;s expectancies regarding future outcomes that also relates to motivation. ten-items comprise a combination of direct scored, reverse-scored and filler items. Score Range of (0\u0026ndash;13) reflects Low Optimism/ High Pessimism, (14\u0026ndash;18): Moderate Optimism and (19\u0026ndash;24): High Optimism.\u003c/p\u003e\n \u003cp\u003eSelf-efficacy was assessed using the Arabic version \u003cstrong\u003e(Rudwan et al.,1997)\u003c/strong\u003e of general efficacy scale (GES) \u003cstrong\u003e(Schwarzer et al, 1995).\u003c/strong\u003e This scale is a self-report measure of self-efficacy, which measures a participant\u0026rsquo;s confidence in their ability to respond to environmental demands and challenges. 10 items with a 4-point Likert response scale ranging from 1 (\u0026ldquo;not at all true\u0026rdquo;) to 4 (\u0026ldquo;exactly true\u0026rdquo;). the total score ranges between 10 and 40, with a higher score than 29 reflects high self-efficacy, score less than 29 reflects low self-efficacy.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical analysis\u003c/h2\u003e\n \u003cp\u003eThe collected data were coded, tabulated, and statistically analysed using IBM SPSS statistics (Statistical Package for Social Sciences) software version 28.0, IBM Corp., Chicago, USA, 2021. Quantitative data tested for normality using Shapiro-Wilk test, then described as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD (standard deviation) as well as minimum and maximum of the range, and then compared using independent t-test (two independent groups) and ANOVA test (three independent groups). Qualitative data described as number and percentage and compared using Chi square test as well as Fisher\u0026rsquo;s Exact test for variables with small, expected numbers. Linear regression models were used to find out independent factors affecting certain conditions. ROC curve was used to evaluate the performance of different tests differentiate between certain subgroups. The level of significance was taken at p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.050 was significant, otherwise was non-significant.\u003c/p\u003e\n \u003cp\u003eDiagnostic characteristics was calculated as follows:\u003c/p\u003e\n \u003cp\u003e- Sensitivity = (True positive test / Total positive golden) x 100\u003c/p\u003e\n \u003cp\u003e- Specificity = (True negative test / Total negative golden) x 100\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study sample comprised seventy (70) elderly participants, men, sixty years and above, the mean age of the participants was 69 years (frail group),68 years (control group). The 2 groups were matched regarding demographic and socio-economic characteristics. BMI was significantly lower in frail group. Sleep problems, social inactivity, and high pain grades were significantly more frequent in frail group as shown in (table 1).\u003c/p\u003e \u003cp\u003eMNA and IADL scores were significantly lower in the frail group. Malnutrition was significantly more frequent in the frail group. GDS score was significantly higher in the frail group (table 2).\u003c/p\u003e \u003cp\u003eAs regards comorbidities, DM was Significantly more frequent in the frail group. Comorbidities Numbers was significantly higher in the frail group (table 3). As regard medication, there was no significant difference regarding number of medications taken by both groups, but administration of Statin, ACEI and Aspocid were significantly less frequent in frail group (table 4).\u003c/p\u003e \u003cp\u003eSelf-efficacy as measured by SES and optimism as measured by R-LOT were significantly lower in the frail group, as shown in (Figs.\u0026nbsp;1\u0026amp;2). R-LOT and SES had significant moderate diagnostic performance in predicting frailty; their cutoff points had moderate sensitivity and low specificity as shown in table (5) \u0026amp; figure (3). There is positive correlation between self-efficacy and optimism; self-Efficacy was significantly lowest in cases with low Optimism as measured by R-LOT with no significant difference between moderate and high grades -Table\u0026nbsp;(6).\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eTable\u0026nbsp;(1): Sociodemographic characteristics of the study groups\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eFrail group\u003c/p\u003e \u003cp\u003e(Total\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e(Total\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c3\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e67.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e^0.195\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eRange\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61.0\u0026ndash;78.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62.0\u0026ndash;79.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c3\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eIlliterate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (37.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (37.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e#0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eIlliterate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (62.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22 (62.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c3\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eCare giver\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eFamily\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33 (94.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026sect;\u0026nbsp;0.493\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003ePaid\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (5.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c3\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eMarried\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28 (80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31 (88.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e#0.324\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eUnmarried\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (11.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c3\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eLiving arrangement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eAlone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (8.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (11.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026sect;\u0026nbsp;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eWith Spouse\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32 (91.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31 (88.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePresence of Social events in the last 6 months\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 (25.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e#0.203\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePresence of Economic problems\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e#0.314\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c3\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (25.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e#0.203\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eCurent/Ex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26 (74.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e^0.010*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRange\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.0\u0026ndash;29.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.0\u0026ndash;28.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eBMI categories\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eUnderweight\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (51.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e#\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLean/over\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (48.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30 (85.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSleep problems\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (34.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e#\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003elack of social activities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (34.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e#0.002*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ePain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (34.3%) a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20 (57.1%) a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e#0.015*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMild\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (40.0%) a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (40.0%) a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (25.7%) a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (2.9%) b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e^Independent t-test. #Chi square test. \u0026sect;Fisher\u0026rsquo;s Exact test. *Significant\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eTable\u0026nbsp;(2): Comprehensive Geriatric Assessment (CGA) among the study groups\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrail group\u003c/p\u003e \u003cp\u003e(Total\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e(Total\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMNA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e^\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRange\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.0\u0026ndash;26.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.0\u0026ndash;28.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eNutritional status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNormal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (31.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (77.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e#\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAt risk/Mal.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (68.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (22.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMMSE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e^0.230\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRange\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.0\u0026ndash;30.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.0\u0026ndash;30.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGDS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e^\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRange\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.0\u0026ndash;4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0\u0026ndash;4.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eIADL\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e^\u0026lt;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRange\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.0\u0026ndash;6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.0\u0026ndash;8.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e^Independent t-test. #Chi square test\u0026sect; Fisher\u0026rsquo;s Exact test. *Significant\u003c/p\u003e \u003cp\u003eMNA (mini nutritional assessment)- MMSE (mini-mental state examination)- GDS (geriatric depression score)- IADL (instrumental activity of daily living)\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eTable\u0026nbsp;(3): Comorbidities among the study groups\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrail group\u003c/p\u003e \u003cp\u003e(Total\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e(Total\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eComorbidities\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (57.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e#0.016*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHypertension\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (45.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (34.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e#0.329\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIHD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e#0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStroke\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (8.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026sect;\u0026nbsp;0.614\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCKD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (17.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e#0.743\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCLD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (45.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (31.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e#0.220\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCOPD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e#0.145\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnemia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (25.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (17.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e#0.382\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThyroid\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (5.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (5.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e#0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eComorbidities numbers\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e^0.004*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRange\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u0026ndash;6.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0\u0026ndash;4.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e^Independent t-test. #Chi square test. \u0026sect;Fisher\u0026rsquo;s Exact test. *Significant\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eTable\u0026nbsp;(4): Medication among the study groups\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eMedications\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStatin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (45.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e#0.029*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eACEI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (34.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (62.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e#0.017*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVitamin-D\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (37.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (51.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e#0.229\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAspocid\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (34.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e#0.031*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMedications number\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e^0.563\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRange\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0\u0026ndash;11.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.0\u0026ndash;10.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e^Independent t-test. #Chi square test. \u0026sect;Fisher\u0026rsquo;s Exact test. *Significant\u003c/p\u003e \u003cp\u003eACEI (angiotensin- converting enzyme inhibitor)\u003c/p\u003e \u003cp\u003e \u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eTable\u0026nbsp;(5): Diagnostic performance of R-LOT and SES in predicting frailty.\u003c/span\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eR-LOT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSES\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAUC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.755\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.714\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.002*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.643\u0026ndash;0.866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.591\u0026ndash;0.837\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCut point\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;17.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;30.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSensitivity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSpecificity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eAUC: Area under curve. SE: Standard error. CI: Confidence interval, *significant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;(6): Comparison between cases with Low, moderate and high Optimism as measured by R-LOT regarding Self Efficacy\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabf\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eR-LOT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003cp\u003e(Total\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003cp\u003e(Total\u0026thinsp;=\u0026thinsp;10)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003cp\u003e(Total\u0026thinsp;=\u0026thinsp;3)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSES score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.5a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.3\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e^0.031*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSES categories\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (72.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (70.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026sect;\u0026nbsp;0.459\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHigh\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (30.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e^Independent t-test. \u0026sect;Fisher\u0026rsquo;s Exact test.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the study, health-related factors affecting the frailty of the subjects were derived from CGA of the patients participating in the study. Among factors that had a statistically significant effect on frailty, BMI was significantly lower in frail group (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Sleep problems(p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001), lack of social activities (p-value\u0026thinsp;=\u0026thinsp;0.002), and high pain grades(p-value\u0026thinsp;=\u0026thinsp;0.015) significantly more frequent in frail group.\u003c/p\u003e \u003cp\u003eThe mean BMI among frail group was (19.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7) with under-weight (51.4%), this was agreed with Xu et al., \u003cspan citationid=\"CR84\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, Wu et al., \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e2021\u003c/span\u003e \u003cb\u003eAu et al.,2021, Bichels et al.,2021.\u003c/b\u003e Rietman et al., \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e2018\u003c/span\u003e. U-shaped association was observed between BMI and physical frailty; underweight as well as obesity is associated with physical frailty. Our results may be attributed to our sample gender being only males, compared to previous studies frail males and females were included. Higher overweight prevalence is observed more frequently among females, compared to higher underweight prevalence among frail males (Jayanama et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFrail group reported high pain grades (65.7%) compared to control group (15%). This agreed with \u003cb\u003ePedro et al., 2019\u003c/b\u003e, Yamada et al., \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, Chen et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2019\u003c/span\u003e, who found that, there is an association between chronic pain and frailty in terms of prevalence. With higher prevalence among underweight frail males Yamada et al., \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, sleep problems \u003cb\u003eHiroya et al., 2022\u003c/b\u003e and depression liu et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2021\u003c/span\u003e. Chronic pain in frail elderly mediates sleep disorders and influences falls. \u003cb\u003eHiroya et al., 2022\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eSleep problems show higher prevalence among frail group (80%), compared to (34.3%) among controls, our study is consistent with, Pourmotabbed et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, Lorber et al., \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e2023\u003c/span\u003e \u003cb\u003eand Madan et al., 2023.\u003c/b\u003e daytime drowsiness, sleep disordered breathing, and prolonged sleep latency enhanced the risk of frailty Pourmotabbed et al., \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e2020\u003c/span\u003e. Higher sleep fragmentation index was associated with frailty and mortality. Greater wake after sleep onset and lower percent sleep were associated with mortality Guida et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2021\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eAs regards lack of social activities, it was more prevalent among frail group (71.4%), than control (34.3%). our study agreed with Davies et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, \u003cb\u003eMehrabi et al., 2020 and\u003c/b\u003e Gale et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2018\u003c/span\u003e, high levels of loneliness and social isolation were associated with an increased risk of becoming physically frail or pre-frail later especially in men.\u003c/p\u003e \u003cp\u003eAs regard comprehensive geriatric assessment, MNA and IADL were significantly lower in the frail group(p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). GDS score was significantly higher in the frail group. (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001)\u003c/p\u003e \u003cp\u003eWe found that malnutrition/ at risk was significantly more frequent in the frail group (68.6%), compared to control (22.9%), these findings agreed with Zhang et al., \u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, O'Leary et al., \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e2020\u003c/span\u003e,\u003c/p\u003e \u003cp\u003eAs regard IADL. frail elderlies were more dependent (IADL scores 4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9) compared to control group (IADL scores 7.7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7). our study agreed with a systematic review by Zamudio-Rodr\u0026iacute;guez et al., \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, P\u0026eacute;rez-Ros et al., \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e2020\u003c/span\u003e Kojima \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2016\u003c/span\u003e. Overall, frail older people were more likely to develop or worsen disabilities in ADL and IADL.\u003c/p\u003e \u003cp\u003eAlthough in our study we excluded elderly with depression, frail elderly scored higher in GDS (3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8) compared to lower GDS scores in control group (1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3). Wang et al., \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, \u003cb\u003eBuigues et al.,2015\u003c/b\u003e Nascimento et al., \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e2016\u003c/span\u003e concluded that depression is more prevalent among frail elderly with higher susceptibility among female, aged 75\u0026ndash;79 years, with lower schooling and income, widow/widowers, higher number of disabilities and diseases, and those who met the criteria for frailty and pre-frailty. \u003cb\u003e(\u003c/b\u003eWoldesemayat et al., \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eCo-morbidities Numbers was significantly higher in the frail group (2.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4) compared to (1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1). DM was significantly more frequent in frail group (57.1%). We agreed with \u003cb\u003eVetrano et al., 2019, Hanlon et al., 2018\u003c/b\u003e that there is a bidirectional association between multimorbidity and frailty. Most frail individuals are also multimorbid, but fewer multimorbid ones also present frailty. multimorbidity also increase the risk of mortality in frail patients.\u003c/p\u003e \u003cp\u003eHubbard et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2010\u003c/span\u003e \u003cb\u003eand\u003c/b\u003e Bund\u0026oacute; et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2023\u003c/span\u003e concluded that Frail older adults were 2.62 times more likely to have a complication of diabetes, independent of age, sex and number of years living with diabetes.\u003c/p\u003e \u003cp\u003eOverall, there was no statistical difference regarding number of medications between frail (mean\u0026thinsp;=\u0026thinsp;5.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3) and non-frail group (mean\u0026thinsp;=\u0026thinsp;4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8). Administration of Statin (45.7%in frails) (71.4% in controls), ACEI (34.3%in frails) (62.9% in controls) and Aspocid (34.3%in frails) (60% in controls) were significantly less frequent in frail group. Our study agreed with \u0026Ouml;ZT\u0026Uuml;RK et al., \u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, Yoshimura et al., \u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, Hanna et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, that frail elderly take fewer protective medications. This could be due to financial burden, drugs adverse effect, care giver issues, advanced age, negative believes about usefulness of such medication in advanced age and its role in decreasing mortality/ morbidity. Mantelli et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2018\u003c/span\u003e in a cross-sectional survey in Swiss GPs; 98% of GPs deprescribed at least one medication for no indication/ no added benefit if frail elderly, this including: aspirin, enalapril, amlodipine, and pantoprazole, atorvastatin, antidepressant and tramadol.\u003c/p\u003e \u003cp\u003eSelf-efficacy as measured by SES was25.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5 in frail group and 28.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6% in control group) and optimism as measured by R-LOT was 12.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3 in frail group and 16.6\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4 in control group. SES and R-LOT scores were significantly lower in the frail group, with positive correlation between R-LOT and SES scores. Self-Efficacy was significantly lowest in cases with low Optimism as measured by R-LOT with no significant difference between moderate and high grades.\u003c/p\u003e \u003cp\u003eWe explored the relationship between frailty and both self-efficacy and optimism as possible psychosocial determinants of physical frailty. Self-efficacy by definition\u0026rdquo; is an individual's belief in his or her capacity to execute behaviours necessary to produce specific performance attainments\u0026rdquo; \u003cb\u003e(\u003c/b\u003eBandura, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e1997\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e Self-efficacy represents confidence in the ability to exert control over one's own motivation, behaviour, and social environment. Enhancing self-efficacy can improve the outcomes and quality of life for patients living with chronic diseases \u003cb\u003e(\u003c/b\u003eFarley, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAs regard self-efficacy we concluded that there is negative corelation between self- efficacy and frailty. Our study agreed with Li et al., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, Lin CH et al., \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, Hladek et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2020\u003c/span\u003e Doba et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2016\u003c/span\u003e. That frail elderly show low levels of self-efficacy; elderly with high coping self-efficacy is associated with lower odds of pre-frailty/frailty even with chronic disease.\u003c/p\u003e \u003cp\u003eOn the other hand, dispositional Optimism -by definition- is the generalized, relatively stable tendency to expect good outcomes across important life domains \u003cb\u003e(Scheier et al., 2018).\u003c/b\u003e The relation between dispositional optimism and better adjustment to diverse stressors may be attributable to optimism's effects on coping strategies \u003cb\u003e(Nes et al.,2006).\u003c/b\u003e there is negative corelation between dispositional optimism and frailty. Optimistic seniors cope better with aging/ life stressors, In Wang et al., \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e2022\u003c/span\u003e study, optimism, resilience, higher levels of tenacity, strength were associated with lower prevalence of frailty. This agreed \u003cb\u003ewith\u003c/b\u003e Wang et al., \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e2022\u003c/span\u003e, \u003cb\u003eKim \u0026amp; Won ,2022\u003c/b\u003e Sardella et al., \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e2021\u003c/span\u003e.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur findings confirmed that, there is a relation between the general self-efficacy, optimism, and frailty. SES and R-LOT scales had moderate diagnostic accuracy in predicting frailty; thus, these scales could be used as part of comprehensive evaluation of frail elderly for psychosocial evaluation of frailty. Considering these findings, medical staff/geriatrician should pay closer attention Addressing psycho-social interventions of self-efficacy and optimism. This could add benefits to elderly in delaying the onset of frailty and/or protecting against adverse outcomes of physical frailty. This should be done side by side to other factors such as: nutrition, physical exercises, polypharmacy, depression, sleep, social isolation, and other novel interventions of frailty.\u003c/p\u003e "},{"header":"Limitations of the study","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003cp\u003eWe acknowledge that there were some limitations to this study. It was limited by first, its narrow sample size. Second, this study used a case-control research design, which meant that the causal relationships between some study variables could not be identified accurately due to the presence of confounding factors. Further studies need to be conducted with larger sample size to identify factors affecting SES and R-LOT. Interventional psychological and behavioural studies need to be addressed to determine the possibility of protective effect of self- efficacy and optimism on frail elderly.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGSES\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGeneral Self Efficacy Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eR-LOT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRevised- Life Orientation Test\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCGA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComprehensive Geriatric Assessment\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMNA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMini Nutritional Assessment\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMMSE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMini Mental State Examination\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGDS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGeriatric Depression Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eADL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eActivity of daily living\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIADL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInstrumental activity of daily living\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePFP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePhysical Frailty Phenotype.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethical Committee of Ain Shams University Hospitals (9/8/2022).\u0026nbsp;All procedures were conducted within the ethical guidelines as outlined in the Declaration of Helsinki and its later amendments. All study participants were interviewed during clinic visits, confirm confidentiality, and obtain their informed written consent for participation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available. from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eD.A. was responsible for data collection and analysis, writing and editing; H.S. was responsible for revising data collection and \u0026nbsp;revising the manuscript; N.H. was responsible for revising data collection, helped in the interpretation of data, formal analysis ,contributed in writing, revising the manuscript D.R. was responsible for the conceptualization and work design, contributed in writing, formal analysis of data, final revision of the manuscript \u0026nbsp;; H.H was responsible for revising the manuscript. All authors have approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all seniors who participated in the study for their time and effort.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAfek, A., Ben-Avraham, R., Davidov, A., Berezin Cohen, N., Ben Yehuda, A., Gilboa, Y., \u0026amp; Nahum, M. (2021). Psychological Resilience, Mental Health, and Inhibitory Control Among Youth and Young Adults Under Stress. \u003cem\u003eFrontiers in psychiatry\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e, 608588. https://doi.org/10.3389/fpsyt.2020.608588\u003c/li\u003e\n\u003cli\u003eAu PC, Li HL, Lee GK, Li GH, Chan M, Cheung BM, et al. (2021). Sarcopenia and mortality in cancer: A meta-analysis. Osteoporos Sarcopenia. 7(Supply 1), S28\u0026ndash;33. https://doi.org/10.1016/j.afos.2021.03.002.\u003c/li\u003e\n\u003cli\u003eAvila-Funes, J. A., Helmer, C., Amieva, H., Barberger-Gateau, P., Le Goff, M., Ritchie, K., Portet, F., Carri\u0026egrave;re, I., Tavernier, B., Guti\u0026eacute;rrez-Robledo, L. M., \u0026amp; Dartigues, J. F. (2008). Frailty among community-dwelling elderly people in France: the three-city study. \u003cem\u003eThe journals of gerontology. Series A, Biological sciences and medical sciences\u003c/em\u003e, \u003cem\u003e63\u003c/em\u003e(10), 1089\u0026ndash;1096. https://doi.org/10.1093/gerona/63.10.1089\u003c/li\u003e\n\u003cli\u003eBandura, A. (1997). \u003cem\u003eSelf-efficacy: The exercise of control.\u003c/em\u003e W H Freeman/Times Books/ Henry Holt \u0026amp; Co.\u003c/li\u003e\n\u003cli\u003eBichels AV, Cordeiro AC, Avesani CM, Amparo FC, Giglio J, Souza NC, et al. (2021). Muscle Mass Assessed by Computed Tomography at the Third Lumbar Vertebra Predicts Patient Survival in Chronic Kidney Disease. J Ren Nutr. 31(4),342\u0026ndash;50. https://doi.org/10.1053/j.jrn.2020.05.007.\u003c/li\u003e\n\u003cli\u003eBund\u0026oacute;, M., Vlacho, B., Lluss\u0026agrave;, J., Bob\u0026eacute;, I., Aivar, M., Ciria, C., Mart\u0026iacute;nez-S\u0026aacute;nchez, A., Real, J., Mata-Cases, M., Cos, X., D\u0026ograve;ria, M., Viade, J., Franch-Nadal, J., \u0026amp; Mauricio, D. (2023). Prediction of outcomes in subjects with type 2 diabetes and diabetic foot ulcers in Catalonian primary care centers: a multicenter observational study. \u003cem\u003eJournal of foot and ankle research\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(1), 8. https://doi.org/10.1186/s13047-023-00602-6\u003c/li\u003e\n\u003cli\u003eCarver, C. S., \u0026amp; Scheier, M. F. (2014). Dispositional optimism. \u003cem\u003eTrends in cognitive sciences\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(6), 293\u0026ndash;299. https://doi.org/10.1016/j.tics.2014.02.003\u003c/li\u003e\n\u003cli\u003eChen, C., Winterstein, A. G., Fillingim, R. B., \u0026amp; Wei, Y. J. (2019). Body weight, frailty, and chronic pain in older adults: a cross-sectional study. \u003cem\u003eBMC geriatrics\u003c/em\u003e, \u003cem\u003e19\u003c/em\u003e(1), 143. https://doi.org/10.1186/s12877-019-1149-4\u003c/li\u003e\n\u003cli\u003eChesney, M. A., Neilands, T. B., Chambers, D. B., Taylor, J. M., \u0026amp; Folkman, S. (2006). A validity and reliability study of the coping self-efficacy scale. \u003cem\u003eBritish journal of health psychology\u003c/em\u003e, \u003cem\u003e11\u003c/em\u003e(Pt 3), 421\u0026ndash;437. https://doi.org/10.1348/135910705X53155\u003c/li\u003e\n\u003cli\u003eConversano, C., Poli, A., Ciacchini, R., Hitchcott, P., Bazzichi, L., \u0026amp; Gemignani, A. (2019). A psychoeducational intervention is a treatment for fibromyalgia syndrome. \u003cem\u003eClinical and experimental rheumatology\u003c/em\u003e, \u003cem\u003e37 Suppl 116\u003c/em\u003e(1), 98\u0026ndash;104.\u003c/li\u003e\n\u003cli\u003eCristina Buigues, Celia Padilla-S\u0026aacute;nchez, Julio Fern\u0026aacute;ndez Garrido, Rut Navarro-Mart\u0026iacute;nez, Vicente Ruiz-Ros \u0026amp; Omar Cauli (2015). The relationship between depression and frailty syndrome: a systematic review, Aging \u0026amp; Mental Health, 19:9, 762-772, DOI: 10.1080/13607863.2014.967174\u003c/li\u003e\n\u003cli\u003eCrum, R. M., Anthony, J. C., et al., (1993). Population-\u003cspan dir=\"RTL\"\u003e \u003c/span\u003ebased norms for the Mini-Mental State Examination by\u003cspan dir=\"RTL\"\u003e \u003c/span\u003eage and educational level. Jama, 269(18), 2386-2391.\u003c/li\u003e\n\u003cli\u003eDavide L Vetrano, MD and others (2019). Frailty and Multimorbidity: A Systematic Review and Meta-analysis, The Journals of Gerontology: Series A, Volume 74, Issue 5, Pages 659\u0026ndash;666, https://doi.org/10.1093/gerona/gly110\u003c/li\u003e\n\u003cli\u003eDavies, K., Maharani, A., Chandola, T., Todd, C., \u0026amp; Pendleton, N. (2021). The longitudinal relationship between loneliness, social isolation, and frailty in older adults in England: a prospective analysis. \u003cem\u003eThe lancet. Healthy longevity\u003c/em\u003e, \u003cem\u003e2\u003c/em\u003e(2), e70\u0026ndash;e77. https://doi.org/10.1016/S2666-7568(20)30038-6\u003c/li\u003e\n\u003cli\u003eDel Corno, F., and Kiosses, D. N. (2018). The PDM-2 perspective on later life. Psychoanal. Psychol. 35, 346\u0026ndash;350.\u003c/li\u003e\n\u003cli\u003eDent, E., Morley, J. E., Cruz-Jentoft, A. J., Woodhouse, L., Rodr\u0026iacute;guez-Ma\u0026ntilde;as, L., Fried, L. P., Woo, J., Aprahamian, I., Sanford, A., Lundy, J., Landi, F., Beilby, J., Martin, F. C., Bauer, J. M., Ferrucci, L., Merchant, R. A., Dong, B., Arai, H., Hoogendijk, E. O., Won, C. W., \u0026hellip; Vellas, B. (2019). Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. \u003cem\u003eThe journal of nutrition, health \u0026amp; aging\u003c/em\u003e, \u003cem\u003e23\u003c/em\u003e(9), 771\u0026ndash;787. https://doi.org/10.1007/s12603-019-1273-z\u003c/li\u003e\n\u003cli\u003eDoba, N., Tokuda, Y., Saiki, K., Kushiro, T., Hirano, M., Matsubara, Y., \u0026amp; Hinohara, S. (2016). Assessment of Self-Efficacy and its Relationship with Frailty in the Elderly. Internal Medicine, 55(19), 2785\u0026ndash;2792. https://doi.org/10.2169/internalmedicine.55.6924\u003c/li\u003e\n\u003cli\u003edoi: 10.1037/pap0000190\u003c/li\u003e\n\u003cli\u003edoi: 10.1186/s12916-022-02596-7. PMID: 36280863; PMCID: PMC9594976.\u003c/li\u003e\n\u003cli\u003eDos Santos, S. B., Rocha, G. P., Fernandez, L. L., de Padua, A. C., \u0026amp; Reppold, C. T. (2018). Association of Lower Spiritual Well-Being, Social Support, Self-Esteem, Subjective Well-Being, Optimism and Hope Scores With Mild Cognitive Impairment and Mild Dementia. Frontiers in psychology, 9, 371. https://doi.org/10.3389/fpsyg.2018.00371\u003c/li\u003e\n\u003cli\u003eEl-Okl MA, Elbanoby MH, Eletrby MA, Mortagy AK and Elsaied MN (2002). Prevalence of Alzheimer dementia and other causes of dementia in Egyptian elderly. MD thesis, Faculty of Medicine, Ain Shams University. Geriatric Department Library.\u003c/li\u003e\n\u003cli\u003eFarley H. (2019). Promoting self-efficacy in patients with chronic disease beyond traditional education: A literature review. \u003cem\u003eNursing open\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e(1), 30\u0026ndash;41. https://doi.org/10.1002/nop2.382\u003c/li\u003e\n\u003cli\u003eFolstein, M. F., Folstein, S. E., \u0026amp; McHugh, P. R. (1975). \u0026quot;Mini-mental state\u0026quot;. A practical method for grading the cognitive state of patients for the clinician. \u003cem\u003eJournal of psychiatric research\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(3), 189\u0026ndash;198. https://doi.org/10.1016/0022-3956(75)90026-6\u003c/li\u003e\n\u003cli\u003eFried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W. J., Burke, G., McBurnie, M. A., \u0026amp; Cardiovascular Health Study Collaborative Research Group (2001). Frailty in older adults: evidence for a phenotype. \u003cem\u003eThe journals of gerontology. Series A, Biological sciences and medical sciences\u003c/em\u003e, \u003cem\u003e56\u003c/em\u003e(3), M146\u0026ndash;M156. https://doi.org/10.1093/gerona/56.3.m146\u003c/li\u003e\n\u003cli\u003eGaddey HL, Holder KK. (2021). Unintentional Weight Loss in Older Adults. Am Fam Physician. 104(1):34\u0026ndash;40.\u003c/li\u003e\n\u003cli\u003eGale, C. R., Westbury, L., \u0026amp; Cooper, C. (2018). Social isolation and loneliness as risk factors for the progression of frailty: the English Longitudinal Study of Ageing. \u003cem\u003eAge and ageing\u003c/em\u003e, \u003cem\u003e47\u003c/em\u003e(3), 392\u0026ndash;397. https://doi.org/10.1093/ageing/afx188\u003c/li\u003e\n\u003cli\u003eGobbens, R. J. J., \u0026amp; Andreasen, J. (2020). The prediction of readmission and mortality by the domains and components of the Tilburg Frailty Indicator (TFI): A prospective cohort study among acutely admitted older patients. \u003cem\u003eArchives of gerontology and geriatrics\u003c/em\u003e, \u003cem\u003e89\u003c/em\u003e, 104077. https://doi.org/10.1016/j.archger.2020.104077\u003c/li\u003e\n\u003cli\u003eGobbens, R. J., van Assen, M. A., Augustijn, H., Goumans, M., \u0026amp; van der Ploeg, T. (2021). Prediction of mortality by the Tilburg Frailty Indicator (TFI). \u003cem\u003eJournal of the American Medical Directors Association\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(3), 607-e1. https://doi.org/10.1016/j.jamda.2020.07.033\u003c/li\u003e\n\u003cli\u003eGuida, J. L., Alfini, A. J., Gallicchio, L., Spira, A. P., Caporaso, N. E., \u0026amp; Green, P. A. (2021). Association of objectively measured sleep with frailty and 5-year mortality in community-dwelling older adults. \u003cem\u003eSleep\u003c/em\u003e, \u003cem\u003e44\u003c/em\u003e(7), zsab003. https://doi.org/10.1093/sleep/zsab003\u003c/li\u003e\n\u003cli\u003eGuigoz, Y., Vellas, B. and Garry, P.J. (1994). Mini Nutritional Assessment: A practical Assessment Tool for Grading the Nutritional State of Elderly Patients. In: Vellas, B., Ed., The Mini Nutritional Assessment (MNA), Supplement No 2, Serdi Publisher, Paris, 15-59.\u003c/li\u003e\n\u003cli\u003eHanna, V., Chahine, B., \u0026amp; Al Souheil, F. (2022). Under-prescription of medications in older adults according to START criteria: A cross-sectional study in Lebanon. \u003cem\u003eHealth science reports\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e(5), e759. https://doi.org/10.1002/hsr2.759\u003c/li\u003e\n\u003cli\u003eHiroya Honda, Ryota Ashizawa, Kazuya Kiriyama, Koki Take, Tatsuya Hirase, Shinichi Arizono, Yoshinobu Yoshimoto (2022). Chronic pain in the frail elderly mediates sleep disorders and influences falls, Archives of Gerontology and Geriatrics, Volume 99, 104582, ISSN 0167-4943, https://doi.org/10.1016/j.archger.2021.104582.\u003c/li\u003e\n\u003cli\u003eHladek, M. D., Gill, J., Bandeen-Roche, K., Walston, J. D., Allen, J. K., Hinkle, J. L., Lorig, K., \u0026amp; Szanton, S. L. (2020). High coping self-efficacy associated with lower odds of pre-frailty/frailty in older adults with chronic disease. Aging \u0026amp; Mental Health, 24(12), 1956\u0026ndash;1962. https://doi.org/10.1080/13607863.2019.1639136\u003c/li\u003e\n\u003cli\u003eHladek, M. D., Gill, J., Bandeen-Roche, K., Walston, J., Allen, J., Hinkle, J. L., Lorig, K., \u0026amp; Szanton, S. L. (2020). High coping self-efficacy associated with lower odds of pre-frailty/frailty in older adults with chronic disease. Aging \u0026amp; mental health, 24(12), 1956\u0026ndash;1962. https://doi.org/10.1080/13607863.2019.1639136\u003c/li\u003e\n\u003cli\u003eHoogendijk, E. O., Afilalo, J., Ensrud, K. E., Kowal, P., Onder, G., \u0026amp; Fried, L. P. (2019). Frailty: implications for clinical practice and public health. \u003cem\u003eThe Lancet\u003c/em\u003e, \u003cem\u003e394\u003c/em\u003e(10206), 1365\u0026ndash;1375. https://doi.org/10.1016/s0140-6736(19)31786-6\u003c/li\u003e\n\u003cli\u003eHowlett, S. E., Rutenberg, A. D., \u0026amp; Rockwood, K. (2021). The degree of frailty as a translational measure of health in aging. \u003cem\u003eNature aging\u003c/em\u003e, \u003cem\u003e1\u003c/em\u003e(8), 651\u0026ndash;665. https://doi.org/10.1038/s43587-021-00099-3\u003c/li\u003e\n\u003cli\u003eHubbard, R.E., Andrew, M.K., Fallah, N. and Rockwood, K. (2010). Comparison of the prognostic importance of diagnosed diabetes, co-morbidity and frailty in older people. Diabetic Medicine, 27: 603-606. https://doi.org/10.1111/j.1464-5491.2010.02977.x\u003c/li\u003e\n\u003cli\u003eJang, I. Y., Jung, H. W., Park, H., Lee, C. K., Yu, S. S., Lee, Y. S., Lee, E., Glynn, R. J., \u0026amp; Kim, D. H. (2018). A multicomponent frailty intervention for socioeconomically vulnerable older adults: a designed-delay study. \u003cem\u003eClinical interventions in aging\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e, 1799\u0026ndash;1814. https://doi.org/10.2147/CIA.S177018\u003c/li\u003e\n\u003cli\u003eJayanama K, Theou O, Godin J, Mayo A, Cahill L, Rockwood K. (2022). Relationship of body mass index with frailty and all-cause mortality among middle-aged and older adults. BMC Med. 24;20(1):404.\u003c/li\u003e\n\u003cli\u003eJerome A. Yesavage, T.L. Brink, Terence L. Rose, Owen Lum, Virginia Huang, Michael Adey, Von Otto Leirer (1982). Development and validation of a geriatric depression screening scale: A preliminary report, Journal of Psychiatric Research, Volume 17, Issue 1, 37-49, ISSN 0022-3956, https://doi.org/10.1016/0022-3956(82)90033-4.\u003c/li\u003e\n\u003cli\u003eJoseph, B., Saljuqi, A. T., Amos, J. D., Teichman, A., Whitmill, M. L., Anand, T., Hosseinpour, H., Burruss, S. K., Dunn, J. A., Najafi, K., Godat, L. N., Enniss, T. M., Shoultz, T. H., Egodage, T., Bongiovanni, T., Hazelton, J. P., Colling, K. P., Costantini, T. W., Stein, D. M., Schroeppel, T. J., \u0026hellip; AAST Frailty MIT Study Group (2023). Prospective validation and application of the Trauma-Specific Frailty Index: Results of an American Association for the Surgery of Trauma multi-institutional observational trial. \u003cem\u003eThe journal of trauma and acute care surgery\u003c/em\u003e, \u003cem\u003e94\u003c/em\u003e(1), 36\u0026ndash;44. https://doi.org/10.1097/TA.0000000000003817\u003c/li\u003e\n\u003cli\u003eKATZ, S., FORD, A. B., MOSKOWITZ, R. W., JACKSON, B. A., \u0026amp; JAFFE, M. W. (1963). STUDIES OF ILLNESS IN THE AGED. THE INDEX OF ADL: A STANDARDIZED MEASURE OF BIOLOGICAL AND PSYCHOSOCIAL FUNCTION. \u003cem\u003eJAMA\u003c/em\u003e, \u003cem\u003e185\u003c/em\u003e, 914\u0026ndash;919. https://doi.org/10.1001/jama.1963.03060120024016\u003c/li\u003e\n\u003cli\u003eKim, S., \u0026amp; Won, C. W. (2022). Optimistic orientation and frailty in community-dwelling older adults: Results from KFACS study. \u003cem\u003eExperimental Gerontology\u003c/em\u003e, \u003cem\u003e170\u003c/em\u003e, 111963. https://doi.org/10.1016/j.exger.2022.111963\u003c/li\u003e\n\u003cli\u003eKoga, HK, Trudel-Fitzgerald, C, Lee, LO, et al. (2022). Optimism, lifestyle, and longevity in a racially diverse cohort of women. \u003cem\u003eJ Am Geriatr Soc\u003c/em\u003e. 70(10): 2793- 2804. doi:10.1111/jgs.17897\u003c/li\u003e\n\u003cli\u003eKojima, G. (2016). Frailty as a predictor of disabilities among community-dwelling older people: a systematic review and meta-analysis. \u003cem\u003eDisability and Rehabilitation\u003c/em\u003e, \u003cem\u003e39\u003c/em\u003e(19), 1897\u0026ndash;1908. https://doi.org/10.1080/09638288.2016.1212282\u003c/li\u003e\n\u003cli\u003eLawton MP, Brody EM (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist; 9(3): 179\u0026ndash;186.\u003c/li\u003e\n\u003cli\u003eLee H, Lee E, Jang IY. (2020). Frailty and Comprehensive Geriatric Assessment. J Korean Med Sci. 35(3): e16. https://doi.org/10.3346/jkms.2020.35.e16\u003c/li\u003e\n\u003cli\u003eLi X, Yang K, An Y, Liu M, Yan C, Huang R. (2022). General self-efficacy and frailty in hospitalized older patients: The mediating effect of loneliness. Geriatr Nursing. 48:315-319. doi: 10.1016/j.gerinurse.2022.10.019. Epub 2022 Nov 7. PMID: 36356532.\u003c/li\u003e\n\u003cli\u003eLin CH, Liu CY, Huang CC, Rong JR. (2022). Frailty and Quality of Life among Older Adults in Communities: The Mediation Effects of Daily Physical Activity and Healthy Life Self-Efficacy. Geriatrics (Basel) .7(6):125. doi: 10.3390/geriatrics7060125. PMID: 36412614; PMCID: PMC9680389.\u003c/li\u003e\n\u003cli\u003eLiu M, Hou T, Nkimbeng M, Li Y, Taylor JL, Sun X, Tang S, Szanton SL. (2021). Associations between symptoms of pain, insomnia and depression, and frailty in older adults: A cross-sectional analysis of a cohort study. Int J Nurs Stud. 117:103873. doi: 10.1016/j.ijnurstu.2021.103873. Epub 2021 Jan 12. PMID: 33621722; PMCID: PMC9940903.\u003c/li\u003e\n\u003cli\u003eLorber, M., Kmetec, S., Davey, A., Mlinar Reljić, N., Fekonja, Z., \u0026amp; Kegl, B. (2023). Associations between Sleep Quality, Frailty, and Quality of Life among Older Adults in Community and Nursing Home Settings. \u003cem\u003eInternational journal of environmental research and public health\u003c/em\u003e, \u003cem\u003e20\u003c/em\u003e(6), 4937. https://doi.org/10.3390/ijerph20064937\u003c/li\u003e\n\u003cli\u003eLorenzo-L\u0026oacute;pez, L., Maseda, A., de Labra, C. et al. (2017). Nutritional determinants of frailty in older adults: A systematic review. BMC Geriatric 17, 108. https://doi.org/10.1186/s12877-017-0496-2\u003c/li\u003e\n\u003cli\u003eMadan Jha V. (2022). The prevalence of sleep loss and sleep disorders in young and old adults. \u003cem\u003eAging brain\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e, 100057. https://doi.org/10.1016/j.nbas.2022.100057\u003c/li\u003e\n\u003cli\u003eMantelli, S., Jungo, K.T., Rozsnyai, Z. et al. (2018). How general practitioners would deprescribe in frail oldest-old with polypharmacy \u0026mdash; the LESS study. BMC Fam Pract 19, 169 https://doi.org/10.1186/s12875-018-0856-9\u003c/li\u003e\n\u003cli\u003eMarengoni, A., Angleman, S., \u0026amp; Fratiglioni, L. (2011). Prevalence of disability according to multimorbidity and disease clustering: a population-based study. \u003cem\u003eJournal of comorbidity\u003c/em\u003e, \u003cem\u003e1\u003c/em\u003e, 11\u0026ndash;18.https://doi.org/10.15256/joc.2011.1.3\u003c/li\u003e\n\u003cli\u003eMehrabi, F., \u0026amp; B\u0026eacute;land, F. (2020). Effects of social isolation, loneliness and frailty on health outcomes and their possible mediators and moderators in community-dwelling older adults: A scoping review. \u003cem\u003eArchives of gerontology and geriatrics\u003c/em\u003e, \u003cem\u003e90\u003c/em\u003e, 104119. https://doi.org/10.1016/j.archger.2020.104119\u003c/li\u003e\n\u003cli\u003eMelissa D. Hladek, Jessica Gill, Karen Bandeen-Roche, Jeremy Walston, Jerilyn Allen, Janice L. Hinkle, Kate Lorig \u0026amp; Sarah L. Szanton (2019). High coping self-efficacy associated with lower odds of pre-frailty/frailty in older adults with chronic disease, Aging \u0026amp; Mental Health, DOI: 10.1080/13607863.2019.1639136\u003c/li\u003e\n\u003cli\u003eMorley J. E. (2017). The New Geriatric Giants. \u003cem\u003eClinics in geriatric medicine\u003c/em\u003e, \u003cem\u003e33\u003c/em\u003e(3), xi\u0026ndash;xii. https://doi.org/10.1016/j.cger.2017.05.001\u003c/li\u003e\n\u003cli\u003eNascimento, P. P. P., Batistoni, S. S. T., \u0026amp; Neri, A. L. (2016). Frailty and depressive symptoms in older adults: data from the FIBRA study - UNICAMP. Psicologia: Reflex\u0026atilde;o E Cr\u0026iacute;tica, 29. https://doi.org/10.1186/s41155-016-0033-9\u003c/li\u003e\n\u003cli\u003eNes, L. S., \u0026amp; Segerstrom, S. C. (2006). Dispositional optimism and coping: a meta-analytic review. \u003cem\u003ePersonality and social psychology review: an official journal of the Society for Personality and Social Psychology, Inc\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e(3), 235\u0026ndash;251. https://doi.org/10.1207/s15327957pspr1003_3\u003c/li\u003e\n\u003cli\u003eNieves-Lugo, K., Ware, D., Althoff, K., Brennan-Ing, M., Meanley, S., Brown, A. L., Haberlen, S. A., Masters, M., Egan, J. E., Friedman, M. R., \u0026amp; Plankey, M. (2021). Negative Perception of Aging Is Associated With Frailty Transitions Within a Cohort of Sexual Minority Men. \u003cem\u003eInnovation in aging\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e(4), igab035. https://doi.org/10.1093/geroni/igab035\u003c/li\u003e\n\u003cli\u003eO\u0026apos;Leary, M. F., Barreto, M., \u0026amp; Bowtell, J. L. (2020). Evaluating the Effect of a Home-Delivered Meals Service on the Physical and Psychological Wellbeing of a UK Population of Older Adults - A Pilot and Feasibility Study. Journal of nutrition in gerontology and geriatrics, 39(1), 1\u0026ndash;15. https://doi.org/10.1080/21551197.2019.1684417\u003c/li\u003e\n\u003cli\u003e\u0026Ouml;zt\u0026uuml;rk, E., Ganidagli, S., \u0026amp; \u0026Ouml;zt\u0026uuml;rk, Z. A. (2023). Polypharmacy in the Elderly: A Double-Edged Sword. \u003cem\u003eMedical Records-international Medical Journal\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e(2), 255\u0026ndash;261. https://doi.org/10.37990/medr.1183707\u003c/li\u003e\n\u003cli\u003ePedro Otones Reyes, Eva Garc\u0026iacute;a Perea, Azucena Pedraz Marcos (2019). Chronic Pain and Frailty in Community-Dwelling Older Adults: A Systematic Review, Pain Management Nursing, Volume 20, Issue 4,2019, Pages 309-315, ISSN 1524-9042. https://doi.org/10.1016/j.pmn.2019.01.003.\u003c/li\u003e\n\u003cli\u003eP\u0026eacute;rez-Ros P, Vila-Candel R, L\u0026oacute;pez-Hern\u0026aacute;ndez L, Mart\u0026iacute;nez-Arnau FM. (2020). Nutritional Status and Risk Factors for Frailty in Community-Dwelling Older People: A Cross-Sectional Study. Nutrients.10;12(4):1041. doi: 10.3390/nu12041041. PMID: 32290060; PMCID: PMC7231056.\u003c/li\u003e\n\u003cli\u003ePeter Hanlon, Barbara I Nicholl, Bhautesh Dinesh Jani, Duncan Lee, Ross McQueenie, Frances S Mair (2018). Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality: a prospective analysis of 493 737 UK Biobank participants,The Lancet Public Health,Volume 3, Issue 7, Pages e323-e332,ISSN 2468-2667, https://doi.org/10.1016/S2468-2667(18)30091-4.\u003c/li\u003e\n\u003cli\u003ePourmotabbed, A., Boozari, B., Babaei, A. et al. (2020). Sleep and frailty risk: a systematic review and meta-analysis. Sleep Breath 24, 1187\u0026ndash;1197. https://doi.org/10.1007/s11325-020-02061-w\u003c/li\u003e\n\u003cli\u003eRietman, M. L., van der A, D. L., van Oostrom, S. H., Picavet, H. S. J., Doll\u0026eacute;, M. E. T., van Steeg, H., Verschuren, W. M. M., \u0026amp; Spijkerman, A. M. W. (2018). The Association between BMI and Different Frailty Domains: A U-Shaped Curve?. \u003cem\u003eThe journal of nutrition, health \u0026amp; aging\u003c/em\u003e, \u003cem\u003e22\u003c/em\u003e(1), 8\u0026ndash;15. https://doi.org/10.1007/s12603-016-0854-3\u003c/li\u003e\n\u003cli\u003eRudwan, S.J (1997). Expectations of self-efficacy \u0026quot;theoretical construction and measurement\u0026quot;. Social Affairs Collection, Sharjah ;14(55):25-51.\u003c/li\u003e\n\u003cli\u003eSardella, A., Lenzo, V., Alibrandi, A., Catalano, A., Corica, F., Quattropani, M. C., \u0026amp; Basile, G. (2021). A Clinical Bridge between Family Caregivers and Older Adults: The Contribution of Patients\u0026apos; Frailty and Optimism on Caregiver Burden. \u003cem\u003eInternational journal of environmental research and public health\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(7), 3406. https://doi.org/10.3390/ijerph18073406\u003c/li\u003e\n\u003cli\u003eScheier, M. F., \u0026amp; Carver, C. S. (2018). Dispositional optimism and physical health: A long look back, a quick look forward. American Psychologist, 73(9), 1082\u0026ndash;1094. https://doi.org/10.1037/amp0000384\u003c/li\u003e\n\u003cli\u003eScheier, M. F., Carver, C. S., \u0026amp; Bridges, M. W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test. \u003cem\u003eJournal of personality and social psychology\u003c/em\u003e, \u003cem\u003e67\u003c/em\u003e(6), 1063\u0026ndash;1078. https://doi.org/10.1037//0022-3514.67.6.1063\u003c/li\u003e\n\u003cli\u003eSchoufour, J. D., Mitnitski, A., Rockwood, K., Evenhuis, H. M., \u0026amp; Echteld, M. A. (2013). Development of a frailty index for older people with intellectual disabilities: results from the HA-ID study. \u003cem\u003eResearch in developmental disabilities\u003c/em\u003e, \u003cem\u003e34\u003c/em\u003e(5), 1541\u0026ndash;1555. https://doi.org/10.1016/j.ridd.2013.01.029\u003c/li\u003e\n\u003cli\u003eSchwarzer, R., \u0026amp; Jerusalem, M. \u003cstrong\u003e(1995)\u003c/strong\u003e. Generalized Self-Efficacy scale. In J. Weinman, S. Wright, \u0026amp; M. Johnston,\u003cem\u003e Measures in health psychology: A user\u0026rsquo;s portfolio. Causal and control beliefs\u003c/em\u003e (pp. 35-37). Windsor, UK: NFER-NELSON.\u003c/li\u003e\n\u003cli\u003eSchwarzer, Ralf \u0026amp; Jerusalem, Matthias. (2010). The general self-efficacy scale (GSE). Anxiety, Stress, and Coping. 12. 329-345.\u003c/li\u003e\n\u003cli\u003eShehata AS, Elbanoby MH, Mortagy AK and Ghanem M (1998). Prevalence of depression among Egyptian Geriatric Community. Ain Shams University. Geriatric Department Library.\u003c/li\u003e\n\u003cli\u003eSheikh JA and Yesavage YA (1986). Geriatric Depression Scale. Recent evidence and development of a shorter version. Clinical Gerontology: A Guide to Assessment and Intervention; 165-173, NY: The Haworth Press.\u003c/li\u003e\n\u003cli\u003eSugie, M., Harada, K., Nara, M., Kugimiya, Y., Takahashi, T., Kitagou, M., . . . Ito, H. (2022). Prevalence, overlap, and interrelationships of physical, cognitive, psychological, and social frailty among community-dwelling older people in Japan. Archives of Gerontology and Geriatrics, 100, 104659. https://doi.org/10.1016/j.archger.2022.104659\u003c/li\u003e\n\u003cli\u003eTaylor, M. G., \u0026amp; Carr, D. (2021). Psychological Resilience and Health Among Older Adults: A Comparison of Personal Resources. \u003cem\u003eThe journals of gerontology. Series B, Psychological sciences and social sciences\u003c/em\u003e, \u003cem\u003e76\u003c/em\u003e(6), 1241\u0026ndash;1250. https://doi.org/10.1093/geronb/gbaa116\u003c/li\u003e\n\u003cli\u003eWang, Q., Song, D., Lin, Q., Tao, A., Zhang, Y., Li, X., \u0026amp; Qiu, X. (2023). The critical role of physical frailty and function on depressive symptoms among community-dwelling older adults in China: A cross-sectional study. \u003cem\u003eFrontiers in psychiatry\u003c/em\u003e, \u003cem\u003e14\u003c/em\u003e, 1134427. https://doi.org/10.3389/fpsyt.2023.1134427\u003c/li\u003e\n\u003cli\u003eWang, Y., Chen, Y., Xu, J., Chen, H., \u0026amp; Gao, J. (2022). Association between resilience and frailty among Chinese older adults. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.948958\u003c/li\u003e\n\u003cli\u003eWoldesemayat, E. M., St Clair-Sullivan, N., Kassa, A., Gari, T., Gutema, K., Chea, N., Woubshet, K., Bogale, N., Assefa, A., \u0026amp; Vera, J. (2023). Frailty status and associated factors among older PLHIV in Southern Ethiopia. \u003cem\u003ePloS one\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(4), e0284376. https://doi.org/10.1371/journal.pone.0284376\u003c/li\u003e\n\u003cli\u003eWu, L. C., Kao, H. H., Chen, H. J., \u0026amp; Huang, P. F. (2021). Preliminary screening for sarcopenia and related risk factors among the elderly. \u003cem\u003eMedicine\u003c/em\u003e, \u003cem\u003e100\u003c/em\u003e(19), e25946. https://doi.org/10.1097/MD.0000000000025946\u003c/li\u003e\n\u003cli\u003eXu, L., Zhang, J., Shen, S., Hong, X., Zeng, X., Yang, Y., Liu, Z., Chen, L., \u0026amp; Chen, X. (2020). Association Between Body Composition and Frailty in Elder Inpatients. \u003cem\u003eClinical interventions in aging\u003c/em\u003e, \u003cem\u003e15\u003c/em\u003e, 313\u0026ndash;320. https://doi.org/10.2147/CIA.S243211\u003c/li\u003e\n\u003cli\u003eYamada, K., Kubota, Y., Iso, H., Oka, H., Katsuhira, J., \u0026amp; Matsudaira, K. (2018). Association of body mass index with chronic pain prevalence: a large population-based cross-sectional study in Japan. \u003cem\u003eJournal of anesthesia\u003c/em\u003e, \u003cem\u003e32\u003c/em\u003e(3), 360\u0026ndash;367. https://doi.org/10.1007/s00540-018-2486-8\u003c/li\u003e\n\u003cli\u003eYoshimura, Y., Matsumoto, A., \u0026amp; Momosaki, R. (2022). Pharmacotherapy and the Role of Pharmacists in Rehabilitation Medicine. \u003cem\u003eProgress in rehabilitation medicine\u003c/em\u003e, \u003cem\u003e7\u003c/em\u003e, 20220025. https://doi.org/10.2490/prm.20220025\u003c/li\u003e\n\u003cli\u003eZamudio-Rodr\u0026iacute;guez, A., Letenneur, L., F\u0026eacute;art, C., Avila-Funes, J. A., Amieva, H., \u0026amp; P\u0026eacute;r\u0026egrave;s, K. (2020). The disability process: is there a place for frailty?. \u003cem\u003eAge and ageing\u003c/em\u003e, \u003cem\u003e49\u003c/em\u003e(5), 764\u0026ndash;770. https://doi.org/10.1093/ageing/afaa031\u003c/li\u003e\n\u003cli\u003eZhang, Q., Yu, S., Li, Q., Zhang, M., Meng, L., \u0026amp; Hu, S. (2022). Preoperative Nutritional Status in Elderly Inpatients with Gastrointestinal Cancer and Its Linear Association with Frailty. \u003cem\u003eNutrition and cancer\u003c/em\u003e, \u003cem\u003e74\u003c/em\u003e(4), 1376\u0026ndash;1387. https://doi.org/10.1080/01635581.2021.1955284\u003c/li\u003e\n\u003cli\u003eZhao, J., Liu, J. Y. W., Tyrovolas, S., \u0026amp; Mutz, J. (2023). Exploring the concept of psychological frailty in older adults: a systematic scoping review. \u003cem\u003eJournal of Clinical Epidemiology\u003c/em\u003e. https://doi.org/10.1016/j.jclinepi.2023.05.005\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Ain Shams University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"frailty, self-efficacy, optimism, SES (self-efficacy scale), R-LOT (revised- life orientation test)","lastPublishedDoi":"10.21203/rs.3.rs-3244949/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3244949/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePsychological frailty including cognitive, mood, and motivational components has a major impact on the well- being of frail elderly. Therefore, there is an increasing scientific interest in studying different domains of psychological frailty. Unfortunately, the psychological components of frailty are not completely evaluated and currently there is no consensus regarding appropriate intervention. This study aimed to evaluate self-efficacy and optimism in frail elderly without functional disability. This case-control study was conducted between August 2022 and March 2023, and included 70 elderly male community dwelling participants aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years. The participants were divided into 2 groups: frail and non-frail defined by AVILA modification of Fried criteria. Self-efficacy scale (SES) and Revised-Life orientation test (R-LOT) were applied for all participants.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThose with physical frailty had lower self-efficacy and optimism scores. R-LOT and SES had moderate diagnostic accuracy in predicting frailty; AUC for both tools were 0.75 and 0.71, respectively.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePsychological determinants of frailty are as equally important to be addressed as factors affecting physical frailty. self-efficacy and optimism are both affected in frail elderly. The Self-efficacy scale (SES) and the Revised-Life orientation test (R-LOT) should be applied as a measure of psychological resilience during comprehensive assessment of physical frailty to improve overall well-being and resilience among frail elderly.\u003c/p\u003e","manuscriptTitle":"Self-efficacy and Optimism in frail elderly men without functional disability attending geriatric outpatient clinic in Mansoura university: a case-control study.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-08-09 15:36:33","doi":"10.21203/rs.3.rs-3244949/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ebe18ed3-3ad1-4b76-9e4b-48adf1ec892a","owner":[],"postedDate":"August 9th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":23886924,"name":"Geriatrics \u0026 Gerontology"},{"id":23886925,"name":"Psychiatry"}],"tags":[],"updatedAt":"2023-08-09T15:36:33+00:00","versionOfRecord":[],"versionCreatedAt":"2023-08-09 15:36:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3244949","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3244949","identity":"rs-3244949","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}