On the edge of dependency: how older adults with rheumatoid arthritis experience living with frailty

Up to one third of people with rheumatoid arthritis (RA) are frail, facing increased vulnerability, comorbidities, and psychological challenges. As people with RA live longer, frailty becomes increasingly relevant to clinical care. This study explores how individuals aged ≥65 years with RA experience frailty and how it affects their daily lives and health management.

We conducted an explorative qualitative interview study using purposeful sampling. Participants were recruited from a rheumatology outpatient clinic. Inclusion criteria were age ≥65 years, RA diagnosis, a Multidimensional Health Assessment Questionnaire score >1, and a frailty score, assessed using the Clinical Frailty Scale (CFS), of 4 to 7 (living with very mild frailty to severely frail). We aimed for variation in age, sex, and frailty. The individual semistructured interviews were analysed using reflexive thematic analysis.

Seventeen participants (10 women, mean age 75 years) were included: 4 living with very mild frailty (CFS score 4), 6 mildly frail (CFS score 5), and 7 moderately frail (CFS score 5). The following 3 themes were developed: (1) 'When frailty distorts the life, you once knew', highlighting the emotional toll of facing physical decline, (2) 'The hard shared burden of frailty', exploring the relational dynamics of frailty, and (3) 'Navigating frailty and RA-balancing unmet needs', emphasising the challenges of balancing autonomy and support.

The experience of frailty profoundly shapes the experience of ageing with RA, complicating self-management and challenging both identity and relationships. These findings highlight the need for healthcare systems across sectors to address frailty holistically, supporting both physical and psychosocial needs through coordinated care.