Contribution of health behaviours and clinical factors to socioeconomic differences in frailty among older adults

The lack of social support in elderly populations incurs real societal costs and can lead to their poor health. The aim of this study is to investigate the self-rated health (SRH) and social support among older people as well as its associated factors.We conducted a cross-sectional study among 312 urban community-dwelling elderly aged 65 to 90 years in Tainan Taiwan and Fuzhou Fujian Province from March 2012 to October 2012. A Spearson correlation test, independent t test, a Pearson χ2 test, a linear regression analysis, and a multiple-level model were performed to analyze the results.The participants identified children as the most important source of objective and subjective support, followed by spouse and relatives. Tainan's elderly received more daily life assistance and emotional support, showed stronger awareness of the need to seek help, and maintained a higher frequency of social interactions compared with the elderly in Fuzhou. The mean objective support, subjective support, and support utilization scores as well as the overall social support among Tainan's elderly were significantly high compared with the scores among Fuzhou's elderly. Further, Tainan's elderly rated better SRH than Fuzhou's elderly. Correlation analysis showed that social support was significantly correlated with city, age, living conditions, marital status, and SRH. Multiple linear regression analysis, with social support as a dependent variable, retained the following independent predictors in the final regression model: city (4.792, 95% confidence interval [CI]: 3.068–6.516, P = 0.000), age (−0.805, 95% CI: −1.394 to −0.135, P = 0.013), marital status (−1.260, 95% CI: −1.891 to −0.629, P = 0.000), living conditions (4.069, 95% CI: 3.022–5.116, P = 0.000), and SRH −1.941, 95% CI: −3.194 to −0.688, P = 0.003). The multiple-level model showed that city would impact older people's social support (χ2 = 5.103, P < 0.001). Marital status (−2.133, 95% CI: −2.768 to −1.499, P = 0.000), education (1.697, 95% CI: 0.589–2.805 P = 0.003), living conditions (4.20, 95% CI: 1.762–6.638, P = 0.000), and SRH (−3.144, 95% CI: −4.502 to −1.727, P = 0.000) were the associated factors. Thus, city, age, marital status, education, living conditions, and SRH might be the associated factors for social support among older people.This study presents some feasible implications for social support improvement in China and in other nations worldwide.

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“…[63,64] Evidence also indicates that socioeconomic inequalities in the absolute risk of mortality would obviously increase with age. [65,66] …”

Section: Discussionmentioning

confidence: 99%

Social support and the self-rated health of older people

Dai

Chenyun

Zhang³

et al. 2016

Medicine

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“…Socioeconomic inequalities and disparities throughout a lifetime are important determinants of health, such that experiences in childhood and young adulthood, in addition to midlife and older age, all appear to contribute to frailty in older age [13]. Socioeconomic factors may, in part, be mediated by other behavioral changes such as differences in diet, leisure-time activities [14], or factors associated with chronic stress. Not surprisingly, we found that neurocognitive impairment was one of the strongest risk factors for frailty and slow gait.…”

Section: Discussionmentioning

confidence: 99%

Association Between Frailty and Components of the Frailty Phenotype With Modifiable Risk Factors and Antiretroviral Therapy

Erlandson

Koletar

et al. 2017

The Journal of Infectious Diseases

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“…Studies that made use of a range of socioeconomic indices in relation to the frailty phenotype, 1 first developed in the Cardiovascular Health Study, also show gradients in frailty 7, 8, 9, 10. This inverse socioeconomic gradient is highly relevant to public health policy 11 .…”

Section: Introductionmentioning

confidence: 99%

“…However, the evidence for efficacy of such measures is incomplete. Previous studies examined risk factors measured at age 60 years or older, when intervention might be too late 8, 9, 17. This study addresses this gap in the evidence by analysing the role in frailty inequality of behavioural and biomedical risk factors and disease status at age 50 years.…”

Section: Introductionmentioning

confidence: 99%

Midlife contributors to socioeconomic differences in frailty during later life: a prospective cohort study

Brunner

Shipley

Ahmadi‐Abhari

et al. 2018

The Lancet Public Health

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SummaryBackgroundHealth inequalities persist into old age. We aimed to investigate risk factors for socioeconomic differences in frailty that could potentially be modified through policy measures.MethodsIn this multi-wave longitudinal cohort study (Whitehall II study), we assessed participants' socioeconomic status, behavioural and biomedical risk factors, and disease status at age 45–55 years, and frailty (defined according to the Fried phenotype) at baseline and at one or more of three clinic visits about 18 years later (mean age 69 years [SD 5·9]). We used logistic mixed models to examine the associations between socioeconomic status and risk factors at age 50 years and subsequent prevalence of frailty (adjusted for sex, ethnic origin, and age), with sensitivity analyses and multiple imputation for missing data.FindingsBetween Sept 9, 2007, and Dec 8, 2016, 6233 middle-aged adults were measured for frailty. Frailty was present in 562 (3%) of 16 164 person-observations, and varied by socioeconomic status: 145 (2%) person-observations had high socioeconomic status, 241 (4%) had intermediate status, and 176 (7%) had low socioeconomic status, adjusting for sex and age. Risk factors for frailty included cardiovascular disease, depression, smoking, high or abstinent alcohol consumption, low fruit and vegetable consumption, physical inactivity, poor lung function, hypertension, and overweight or obesity. Cardiometabolic markers for future frailty were high ratio of total to high-density lipoprotein cholesterol, and raised interleukin-6 and C-reactive protein concentrations. The five most important factors contributing to the frailty gradient, assessed by percent attenuation of the association between socioeconomic status and frailty, were physical activity (13%), interleukin-6 (13%), body-mass index category (11%), C-reactive protein (11%), and poor lung function (10%). Overall, socioeconomic differences in frailty were reduced by 40% in the maximally-adjusted model compared with the minimally-adjusted model.InterpretationBehavioural and cardiometabolic risk factors in midlife account for more than a third of socioeconomic differences in frailty. Our findings suggest that interventions targeting physical activity, obesity, smoking, and low-grade inflammation in middle age might reduce socioeconomic differences in later-life frailty.FundingBritish Heart Foundation and British Medical Research Council.

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Contribution of health behaviours and clinical factors to socioeconomic differences in frailty among older adults

Abstract: A lower education or a manual occupation was associated with higher frailty risk in older women. These associations were partly explained by lower alcohol consumption, higher sedentariness, and higher obesity and chronic disease rates in women with lower SES.

Cited by 50 publications

References 39 publications

Social support and the self-rated health of older people

Social support and the self-rated health of older people

Association Between Frailty and Components of the Frailty Phenotype With Modifiable Risk Factors and Antiretroviral Therapy

Midlife contributors to socioeconomic differences in frailty during later life: a prospective cohort study

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