Frailty and its association with mental health and quality of life in multiple sclerosis: A cross-sectional study

Background: With the increasing median age of people with multiple sclerosis (MS), age-related syndromes such as frailty have emerged as new challenges to patient well-being. Prior research on frailty in MS has primarily focused on physical aspects, leaving the relationship between frailty and mental health unexplored. Objective: To investigate the associations between frailty, mental health, and quality of life (QoL) in people with MS. Design: Cross-sectional questionnaire-based study conducted at the Center for MS Care at the University of Kansas Medical Center. Methods: Participants completed validated measures of frailty (Tilburg Frailty Indicator), anxiety and depression (Hospital Anxiety and Depression Scale), QoL (Multiple Sclerosis Quality of Life-54), and disability level (Patient-Determined Disease Steps). Results: A total of 204 patients with MS (median age: 51 (interquartile range = 18) years, 74% women) took part in the study. Overall, 50.5% of respondents were classified as frail. Frail participants were older than their non-frail counterparts ( p = 0.018) and had higher levels of anxiety and depression ( p < 0.001). Frailty status was also associated with lower QoL scores across physical and mental health domains ( p < 0.001). In logistic regression analyses adjusted for age, sex, and disability, higher anxiety scores (odds ratio (OR) = 1.45, 95% confidence interval (CI) (1.28, 1.65), p < 0.001) and depression scores (OR = 1.58, 95% CI (1.365, 1.843), p < 0.001) were associated with greater odds of being frail. Conclusion: This study revealed a strong association between frailty, mental health, and QoL in people with MS. These findings underscore the need for greater attention to both physical and psychological well-being in people with MS. Future research should explore whether integrated care strategies may improve outcomes in this population.