# Self-esteem is associated with health status and PROMs in advanced age independent of multidimensional frailty: secondary analysis from a RCT with 6-month follow-up

## TL;DR

Higher self-esteem in older adults is linked to better health outcomes and quality of life, even after accounting for frailty and other factors.

## Contribution

This study shows self-esteem independently predicts geriatric outcomes beyond frailty measures.

## Key findings

- Baseline self-esteem was significantly associated with pressure ulcer risk and nutritional status.
- Self-esteem correlated with fewer geriatric syndromes and better quality of life.
- Self-esteem was linked to lower depressive symptoms and greater use of geriatric resources.

## Abstract

The predictive value of patient-reported outcome measures (PROMs), such as self-esteem in advanced age in relation to biological age (frailty), remains to be elucidated. In a secondary analysis of a randomised controlled trial (RCT), 107 hospitalised patients (mean age 77.2 (SD 7.1) years, 56% female) underwent a comprehensive geriatric assessment (CGA). Assessments included the Multidimensional Prognostic Index (MPI), the Rosenberg Self-Esteem Scale (RSES), evaluation of geriatric syndromes and resources, the EQ-5D-5L quality-of-life scale, and the Geriatric Depression Scale (GDS). Follow-up data were collected via telephone six months later. After adjusting for age, sex, intervention, and MPI, baseline RSES were significantly associated with pressure ulcer risk (p = 0.009), nutritional status (p = 0.042), number of geriatric syndromes (p = 0.003), geriatric resources (p < 0.001), depressive symptoms (GDS, p < 0.001), and quality of life (EQ-5D-5L, p = 0.020). These findings show that self-esteem appears to be an independent mediator of multiple geriatric outcomes, including geriatric resources and syndromes, as well as of PROMs, beyond what is explained by MPI-based frailty. Incorporating self-esteem measures into CGA may enhance the identification of at-risk individuals and guide interventions.

The online version contains supplementary material available at 10.1007/s10433-025-00888-4.