Household wealth, neighbourhood deprivation and frailty amongst middle-aged and older adults in England: a longitudinal analysis over 15 years (2002-2017)

Frailty-free life expectancy and its association with socio-economic characteristics: an analysis of the English Longitudinal Study of Ageing cohort study

BACKGROUND

Frailty is more prevalent in socio-economically disadvantaged groups; however, little is known about how this translates to differences in the number of years people live with and without frailty. We investigate differences in frailty-free and frail life expectancies among population groups stratified by wealth, area deprivation, education and marital status.

METHODS

The English Longitudinal Study of Ageing cohort study was used to follow the frailty trajectories of 15,003 individuals over 18 years. A multi-state model assessed the risk of transitioning between frailty states and death based on socio-economic characteristics. These risks were translated into state-specific life expectancies.

RESULTS

Wealth had the strongest association with frailty-free and frail life expectancies. Increased wealth, reduced deprivation, higher educational attainment and marriage all correlate with increased frailty-free life expectancies and reduced frail life expectancies. At age 50, the wealthiest population quintile can expect to live 11.1 [10.1-12.1] years (women) and 9.8 [8.8-10.8] years (men) longer frailty-free than the poorest population quintile. The wealthiest quintile live less than half the number of years with frailty than the poorest quintile. There is no difference in frailty-free life expectancy between the poorest men and women; however, the wealthiest women have longer frailty-free life expectancies than the wealthiest men.

CONCLUSIONS

Large inequalities in frailty-free and frail life expectancies exist across socio-economic groups, with wealth and area deprivation the most important socio-economic determinants. Narrowing these inequalities may extend frailty-free life expectancies more for women than men, suggesting strategies to reduce disparities should consider both socio-economic factors and gender. Care policies should account for the geographical clustering of socio-economically disadvantaged populations. Reducing socio-economic inequalities could increase frailty-free life expectancies and reduce health and social care costs.

Frailty, social deprivation, and mortality among Medicare fee-for-service beneficiaries

BACKGROUND

The geographic distribution of frailty and social deprivation, and their association with mortality in the United States, have not been well studied.

METHODS

We estimated claims-based frailty index (CFI) (range: 0-1) and area-level social deprivation index (SDI) (range: 0-100) in a 5% random sample of 1,207,323 Medicare fee-for-service beneficiaries 65 years and older. We examined the prevalence of frailty (defined as CFI ≥ 0.25) and the mean SDI and estimated their correlation by state and county. The association of frailty and social deprivation with one-year mortality was estimated using logistic regression, adjusting for age, sex, and dual eligibility status.

RESULTS

The study population had the following characteristics: mean age of 76 years, 56% female, 10.3% with frailty, and 24.0% with high social deprivation (SDI ≥ 67). The correlation between frailty and social deprivation was weak (ρ = 0.39 by state and 0.28 by county). The risk of death for the total study population was 4.5%. The age, sex, dual eligibility, and SDI-adjusted risk of death for robust, pre-frail, and frail individuals was 1.8%, 4.4%, and 13.3%, respectively. The age, sex, dual eligibility-adjusted risk of death for low, medium, and high SDI regardless of frailty was 4.4%, 4.7%, and 4.6%, respectively. In robust beneficiaries, the adjusted risk of death for low, medium, and high social deprivation was 1.6%, 1.9% (odds ratio [OR]: 1.21 [95% confidence interval, CI: 1.15, 1.27]), and 2.0% (1.31 [1.24, 1.38]), respectively, whereas in beneficiaries with frailty, the corresponding risk by social deprivation was 13.4%, 13.7% (1.03 [0.99, 1.07]), and 12.9% (0.96 [0.92, 1.00]).

CONCLUSION

This study identifies regions of the United States that may be most vulnerable from frailty and social deprivation. These findings emphasize the significance of frailty and social deprivation on mortality and the need for community-based preventative health programs such as frailty screening to improve health outcomes for Medicare beneficiaries living with frailty.

A vicious cycle of frailty and acute lower respiratory infection among community-dwelling adults (≥ 60 years): Findings from a multi-site INSPIRE cohort study, India

We studied the relationship of frailty and acute lower respiratory infection (ALRI) among a multi-site cohort of community-dwelling older adults aged ≥60 years in India. During January 2019‒January 2020, participants completed the Edmonton Frail Scale (EFS) at baseline and every 3 months at four sites in India, with each participant completing a maximum of four surveys. Participants were categorized as non-frail (0-5 points), vulnerable (6-7 points), and frail (≥8 points) based on EFS score. Project nurses made weekly home visits to identify ALRI episodes with onset during past 7 days. We estimated adjusted hazard ratios (aHR) for having an ALRI episode within 90 days after EFS by frailty category. We also assessed risk of deterioration of frailty during 7-100 days after ALRI episode onset in terms of an increased EFS score by ≥1 point and change of frailty category. Among 5801 participants (median age 65 years, 41% males), 3568 (61·5%) were non-frail, 1507 (26%) vulnerable, and 726 (12·5%) frail at enrolment. Compared with non-frail participants, the hazard of an ALRI episode was higher among vulnerable (aHR: 1·6, (95%CI 1·3-2.0) and frail participants (aHR: 1·7, 95%CI 1·3-2·2). Participants having ALRI within the past 7-100 days were at increased risk of worsening frailty category (aOR: 1.9, 95%CI 1·3-2.8) compared to participants without an ALRI episode during the same period. The association between ALRIs and worsened frailty suggests prevention of ALRIs through vaccination and other strategies may have broad reaching health benefits for older adults.

Subjective social status and trajectories of frailty: findings from the English Longitudinal Study of Ageing

Objectives

Subjective social status is a known antecedent for many health outcomes, but little research has examined the association between subjective status and frailty among older people. Using longitudinal data, the goal of this study was, first, to identify latent trajectories of frailty over time, and second, to investigate the relationship between subjective social status and frailty trajectory.

Methods

Data were drawn from the 2002-2019 surveys of the English Longitudinal Study of Ageing, involving 9484 individuals aged 50+ years at baseline. Group-based trajectory models were used to identify frailty trajectories over the 18-year period, and multinomial regression models were used to investigate the relationship between subjective social status and frailty trajectory membership. Controls were included for confounding factors, including a range of socioeconomic indicators and health behaviours.

Results

Four trajectories of the frailty index were retained: low frailty (53% of participants), progressive mild frailty (25%), progressive moderate frailty (15%) and high frailty (6%). Higher subjective social status is associated with higher probabilities of being in the low-frailty group and lower probabilities of being in one of the progressive or high-frailty groups.

Conclusions

Subjective social status is significantly associated with being in a milder frailty trajectory after controlling for age, health behaviours and a wide range of objective socioeconomic status markers.

Higher Dynamic Balance Performance Was Associated With Cognitive Function Among U.S. Community-Dwelling Low-Income Older Adults

Introduction

Multiple studies have reported the association between balance performance and cognitive function among older adults. However, few studies have been conducted in low-income settings.

Objectives

This cross-sectional study examined the relationships of dynamic and static balance with cognitive function in community-dwelling low-income older adults in Orlando, Florida.

Methods

Dynamic balance was assessed with a Short Physical Performance Battery (SPPB) and static balance with BTracks Balance System. Rowland Universal Dementia Assessment Scale (RUDAS) assessed cognition and Patient Health Questionnaire-9 assessed depressive symptoms.

Results

Multiple regression analysis showed dynamic balance was significantly associated with cognition, but static balance was not, controlling for depressive symptoms (N = 89, M age  = 72.70, SD ± 6.95; females = 79). Specifically, higher dynamic balance was associated with better cognitive function. Cognitively healthy participants (RUDAS scores ≥23) scored 2.526 points higher in SPPB than those with possible cognitive impairment (RUDAS scores <23).

Conclusions

Findings provide the evidence to suggest dynamic balance and cognitive function health disparities affecting older adults from low-income community. By implication, dynamic balance and cognitive function should be part of routine screening with older adults living in low-income communities.

Frailty and Environmental Attributes in Older Adults: Insight from an Ecological Model

Many studies on frailty have primarily focused on individual-level risk factors such as demographics and lifestyle. While guidelines for frailty management recommend modifications to an individual's lifestyle, their lifestyle behaviors are significantly influenced by their surroundings. Recently, the association between frailty and environmental attributes has drawn attention as a result of the increase in evidence that multiple factors affect health conditions and behaviors associated with frailty. These findings can be organized based on an ecological model involving five nested levels that influence an individual's behaviors, namely, an intrapersonal/individual core (age, education, and attitude), an interpersonal level (persons and groups), an organizational/institutional level (organization and workplace), a community level (natural, built, and social environments), and a system/public policy level (public policies from local to national). This study reviewed possible factors associated with frailty from the onset and its progression at each level of the ecological model and their implications regarding frailty prevention. Additionally, we introduce a policy-level approach for frailty prevention in Japan-which encourages residents to engage in the local society by participating in community places or groups that are referred to as "Kayoi-no-ba"-and aggregate its status from a government report. This perspective on community building is consistent with the concept of an ecological model. However, few studies have verified the effects of policy- or system-level approaches on disability and frailty prevention. Further studies from an ecological perspective are needed to fulfill multilevel interventions for frailty prevention.