Beyond chronological age: frailty, vitality, and subjective health structured by psychological segmentation in older adults

BACKGROUND: Chronological age remains a dominant factor in clinical decision-making despite its limited ability to reflect individual differences in functioning, vulnerability, and care needs. Age-based decision-making may contribute to exclusion from care and reinforce ageism. Psychological segmentation models, such as the Subjective Health Experience (SHE) model, classify individuals based on acceptance and perceived control of their health condition and have been proposed as a more individualized alternative. However, the relationship between SHE segments and established geriatric assessments such as frailty has not been examined. OBJECTIVE: This study examined how frailty, subjective health experience, and vitality relate to psychological profiles defined by the SHE model, and whether chronological age adds explanatory value beyond segmentation. METHODS: A cross-sectional questionnaire study was conducted among community-dwelling Dutch adults aged ≥67 years (N = 753). Frailty was assessed using the Groningen Frailty Indicator (GFI), subjective health via a self-anchored ladder scale, and vitality via the Vita-16 instrument. Participants were classified into four SHE segments based on mean scores of ≥5.0 per dimension on acceptance and perceived control. Nonparametric analyses were used, with additional age-stratified comparisons (67-75 vs. ≥76 years). RESULTS: Frailty, subjective health, and vitality varied significantly across segments (all p < 0.001). Frailty prevalence ranged from 30% in segment 1%-74% in segment 4 (Cramer's V = 0.41), with low acceptance emerging as the strongest differentiating factor. Segment 1 (high acceptance/high control) showed the most favorable outcomes; segment 4 (low acceptance/low control) showed the poorest. Frailty distinguished intermediate segments more clearly than vitality, with segment 3 (low acceptance/high control) showing higher frailty prevalence than segment 2 (69% vs. 40%). Chronological age did not differ across segments and did not moderate the association between segmentation and health outcomes, except for limited age effects on vitality in segments 1, 2, and 4. CONCLUSION: Psychological segmentation via the SHE model explains meaningful variation in frailty, subjective health, and vitality in older adults, independent of chronological age. Frailty assessment combined with SHE segmentation enables a transition from age-based to needs-based care, supporting more tailored support strategies for older adults.