Ethnic differences in frailty: a cross-sectional study of pooled data from community-dwelling older persons in the Netherlands

Abstract

ObjectiveFew European studies examined frailty among older persons from diverse ethnic backgrounds. We aimed to examine the association of ethnic background with frailty. In addition, we explored the association of ethnic background with distinct components that are considered to be relevant for frailty.Design and settingThis was a cross-sectional study of pooled data of The Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS) in the Netherlands.ParticipantsCommunity-dwelling persons aged 55 years and older with a Dutch, Indonesian, Surinamese, Moroccan or Turkish ethnic background were included (n=23 371).MeasurementsFrailty was assessed with the validated TOPICS-Frailty Index that consisted of 45 items. The TOPICS-Frailty Index contained six components: morbidities, limitations in activities of daily living (ADL), limitations in instrumental ADL, health-related quality of life, psychosocial health and self-rated health. To examine the associations of ethnic background with frailty and with distinct frailty components, we estimated multilevel random-intercept models adjusted for confounders.ResultsTOPICS-Frailty Index scores varied from 0.19 (SD=0.12) among persons with a Dutch background to 0.29 (SD=0.15) in persons with a Turkish background. After adjustment for age, sex, living arrangement and education level, persons with a Turkish, Moroccan or Surinamese background were frailer compared with persons with a Dutch background (p<0.001). There were no significant differences in frailty between persons with an Indonesian compared with a Dutch background. The IADL component scores were higher among all groups with a non-Dutch background compared with persons with a Dutch background (p<0.05 or lower for all groups).ConclusionsCompared with older persons with a Dutch background, persons with a Surinamese, Moroccan or Turkish ethnic background were frailer. Targeted intervention strategies should be developed for the prevention and reduction of frailty among these older immigrants.

Sex differences in frailty: the Frailty Index and the male-female health-survival paradox

“…Thailand (74)(75)(76)(77)(78)(79)(80). The findings of these individual studies were consistent with the findings of this systematic review and would not change the conclusions presented in this Thesis chapter.…”

Global frailty: The role of ethnicity, migration and socioeconomic factors

“…However, completion of instrumental ADLs is heavily biased towards cultural and local knowledge, which may be limited in migrants new to the country. The differences in frailty seen between ethnic minority groups are likely to be related to socioeconomic disadvantage [56]. Social frailty has previously been found to be higher in the Turkish and Surinamese groups in the Netherlands, as well as having higher Frailty Index scores [57].…”

“…For the purpose of this review, a "recent migrant" is anyone considered to be a first-generation migrant in their country of settlement. In the Netherlands, a study involving middle-aged community-dwelling participants (55 years and older) compared indigenous Dutch individuals to Turkish, Indonesian, Surinamese, and Moroccan first generation migrants [56]. Using a 45-item frailty index (TOPICS-Frailty index), after adjusting for confounders, those of Turkish, Moroccan, or Surinamese backgrounds were shown to be frailer than their Dutch counterparts; this wasn't seen with Indonesian migrants.…”

Frailty Triage: Is Rationing Intensive Medical Treatment on the Grounds of Frailty Ethical?

“…Frailty is not evenly distributed among the older population. Studies indicate that rates of frailty are potentially higher in some ethnic groups (Franse et al 2018) and those of low-socio-economic status (Franse et al 2017). So patients from these groups might be less likely to be treated in intensive care if frailty-based triage were permitted.…”