Residential Area Socioeconomic Deprivation is Associated with Physical Dependency and Polypharmacy in Community-Dwelling Older Adults: An Analysis of Health Administrative Data in Ireland

Abstract

Introduction Socioeconomic disadvantage is associated with multiple adverse health outcomes in ageing. Whether this negative impact persists in populations of more advanced age and dependency is less clear. We aimed to determine the association between residential area deprivation and pre-specified health characteristics among community-dwelling dependent older adults. Methods We conducted a cross-sectional analysis of data from 1591 community-dwelling adults aged 65 years and older of mean age 83.9 ± 7.1 years and in receipt of state home support in Ireland. The HP Pobal Deprivation Index was used to categorize residential areas by socioeconomic deprivation. Health variables analysed included physical dependency (Barthel Index), polypharmacy (≥5 medications), previous acute hospital admission, cognitive impairment, and mental health diagnoses. Associations between residential area deprivation and prespecified health outcomes were explored in multivariable logistic regression analysis. Results In socioeconomically disadvantaged areas, high physical dependency was twice that observed in affluent areas (16.2% vs 6.9%, p = 0.009). Similarly, acute hospitalization, as the trigger for increased dependency, was more common in deprived settings (41.6% v 29.1%, p < 0.001). Polypharmacy was common in this population (67.6%), but significantly higher in deprived vs affluent settings (74.7% v 64.5%, p = 0.030). The findings persisted in multivariable analyses when adjusted for age and gender. While all participants were accessing home support, those in deprived areas were on average 6.5 years younger than in affluent areas. Associations between residential deprivation and mental health conditions or cognitive impairment, however, were not observed in this study. Conclusion Community-dwelling older adults living in socioeconomically disadvantaged areas experienced greater polypharmacy, high physical dependency, hospitalization-associated dependency, and a 6.5-year earlier need for state home support than in affluent settings. The findings suggest that health inequality persists in populations of more advanced age and dependency and highlight a need for further research as well as community-based health and social care initiatives.

Assessing Sarcopenia, Frailty, and Malnutrition in Community-Dwelling Dependant Older Adults—An Exploratory Home-Based Study of an Underserved Group in Research

“…Along with assisting with everyday issues including technology. In addition to high levels of physical dependency detected in this group, previous findings, mostly derived from administrative data, identify mental health conditions, social isolation and socioeconomic disadvantage [ 4 , 24 ]. Despite this complexity, the study population expressed a willingness to engage in research, with 93% agreeing to be contacted about future studies.…”

“…Furthermore, low physical activity was prevalent, with participants reporting an estimated 11 daytime hours spent sitting. While these chronic conditions and patterns of sedentary behaviour have been reported in older people in acute settings and in longitudinal datasets [ 20 , 21 , 42 , 43 ], few studies have focused on older populations supported by formal home care [ 24 ]. The findings suggest opportunities for appropriate physical activity and dietary intervention to address sarcopenia, frailty, and malnutrition in this group.…”

“…Convenience sampling was employed to recruit participants from a single government-funded not-for-profit home care organisation in Ireland acting as the study gatekeeper. To ensure diversity of participants, an organisation operating in areas of high and low socioeconomic deprivation was selected, with associations between younger age and receipt of formal home support in areas with high socioeconomic disadvantage previously reported [ 24 ]. Home support in Ireland is allocated based on a health professional assessment of need and is not income assessed.…”

“…Dodds et al suggest it is possible to implement routine sarcopenia assessment in an acute setting and identify a high prevalence of probable sarcopenia (84%) and frailty (66%) in a group of older adults with mean age 80.1 ± 7.7 years ( n = 552) [ 21 ]. In community-based settings, sarcopenia, frailty and malnutrition are not routinely assessed or documented in this underserved older population group, and likely remain undetected and under-treated [ 22 , 23 , 24 ]. Little is known about older adults in the community, receiving formal home support.…”

Study Protocol- The impact of social deprivation on development and progression of diabetic kidney disease

“…The Pobal HP deprivation index has previously been used in medical research looking at polypharmacy and dependency in older adults and on survival post renal transplant and on chronic dialysis (42–44).…”