The relative impact of socioeconomic position and frailty varies by population setting

Abstract

Introduction Frailty and socioeconomic position (SEP) are well‐established determinants of health. However, we know less about the contributions of frailty and SEP in older adults, especially in acute settings. We set out to answer how frailty and SEP might influence health outcomes in older people, comparing a population sample and patients managed by a speciality acute frailty service. Methods We used the Delirium and Population Health Informatics Cohort, a population sample of 1510 individuals aged ≥70 years from the London Borough of Camden and 1750 acute frailty patients. SEP was determined using the Index of Multiple Deprivation. Linear and Cox proportional hazard regression models were conducted to assess SEP on frailty, readmission, and mortality outcomes. Results In the population sample, SEP was significantly associated with frailty and mortality with successive increases in rate of death for each IMD quintile (HR = 1.28, 95% CI 1.11 to 1.49, P < 0.005). Increasing SEP, age, and admission status among hospitalized individuals were associated with greater frailty. For individuals seen by the speciality frailty service, SEP was not associated with frailty, mortality, or readmission. Discussion When older people experience acute illness severe enough to require secondary care, particularly specialist services, this overcomes any prior advantages conferred by a higher SEP.

Socioeconomic deprivation is an important risk factor for frailty in middle-aged and older adults

“…Previous studies have reported that socioeconomic position, neighborhood deprivation were associated with frailty [11,12]. However, these studies did not assess the association between TDI -a newly developed representative index for measuring socioeconomic deprivation -with frailty.…”

Frailty in younger adults in hospital

“…Frailty in older community-dwellers and inpatients is associated with socioeconomic disadvantage. 13 , 14 It seems likely that social vulnerabilities, such as homelessness, unemployment, low education level and poor health literacy, would also be prevalent in frail younger inpatients. Thus, frailty assessment in hospital may be a key opportunity to intervene and mitigate the progression of frailty into older age through individualized multidisciplinary management.…”

The effect of baseline cognition and delirium on long-term cognitive impairment and mortality: a prospective population-based study

“…The Delirium and Population Health Informatics Cohort (DELPHIC) is a prospective longitudinal study of adults aged 70 years or older in the London Borough of Camden (London, UK), a region with 260 000 residents ( figure 1 ). 15 The UK National Health Service (NHS) provides more than 95% of health care, and Camden is served by a single primary care system and two acute hospitals. This report is a planned analysis of approximately the first 1500 participants.…”

“…Our a priori power calculations suggested that a minimum of 11% of the cohort would need to be admitted to hospital, and 70% be followed up, to detect a clinically significant change in long-term cognition (six modified TICS-m points, or approximately 0·3 SD in Z score). 15 We used Stata 17.0 for all analyses.…”