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Social Position and Frailty

Published online by Cambridge University Press:  20 August 2013

Philip D. St. John ,
Patrick R. Montgomery  and
Suzanne L. Tyas
Philip D. St. John*
Affiliation:
Section of Geriatric Medicine, Department of Medicine, and the Centre on Aging, University of Manitoba
Patrick R. Montgomery
Affiliation:
Vancouver Island Health Authority
Suzanne L. Tyas
Affiliation:
School of Public Health and Health Systems, and Department of Psychology, University of Waterloo
*
†Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Philip St. John, M.D., M.P.H., F.R.C.P.C. GE 547 Health Sciences Centre 820 Sherbrook Street University of Manitoba Winnipeg, MB R3A 1R9 (pstjohn@hsc.mb.ca)
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Abstract

This study sought to determine (1) if measures of social position are associated with frailty; (2) if any observed association between social position and frailty is a threshold or gradient effect; and (3) if any observed association is independent of possible confounders. Data were drawn from a sample of 1,751 community-dwelling adults, aged 65 and older, living in the Canadian province of Manitoba in 1991. Education, self-reported income adequacy, and self-reported income satisfaction were used as measures of social position. Frailty was graded based on functional loss, cognition, and urinary incontinence. Multivariate regression analyses revealed, after adjusting for possible confounding factors, that all measures of social position were strongly associated with frailty in a gradient, rather than a threshold, manner. We conclude that social gradients for frailty are present in older adults, although a causal mechanism is not yet clear.

Résumé

Cette étude visait à déterminer (1) si des mesures de position sociale sont associées à la fragilité, (2) si une association observée entre la position sociale et la fragilité est un effet de seuil ou de gradient, et (3) si une relation observée est indépendante des facteurs de confusion possibles. Les données ont été tirées d’un échantillon de 1 751 adultes, habitants des communautés, âgés de 65 ans et plus, habitant la province canadienne de Manitoba en 1991. On a utilisé, comme mesures de la position sociale l’éducation, et la suffisance et la satisfaction du revenu selon auto-évaluation personnelle. La précarité a été classée selon la perte fontionnelle, la cognition et l’incontinence urinaire. Des analyses de régressions multiples ont révelés, après ajustement pour les facteurs possibles de confusion, que toutes les mesures de la position sociale étaient fortement associées à la fragilité par gradient d’effet, plutôt que d’effet de seuil. Nous concluons que les gradients sociaux de la fragilité sont présents chez les adultes âgés, même si un mécanisme causatif n’est pas encore clair.

Keywords

agingaccumulation of deficitsfrailtysocial positionsocioeconomic statusvieillissmentdéficits accumulésfragilité (précarité)position socialestatut socio-économique
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 32 , Issue 3 , September 2013 , pp. 250 - 259
Copyright
Copyright © Canadian Association on Gerontology 2013 

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References

Abellan van Kan, A., Rolland, Y., Bergman, H., Morley, J. E., Kritchevsky, S. B., & Vellas, B. (2008). The I.A.N.A Task Force on frailty assessment of older people in clinical practice. Journal of Nutrition, Health, and Aging, 12(1), 29–37.CrossRefGoogle ScholarPubMed
Ahmed, N., Mandel, R., & Fain, M. J. (2007). Frailty: An emerging geriatric syndrome. American Journal of Medicine, 120, 748–753.Google Scholar
Alvarado, B. E., Zunzunegui, M. V., Beland, F., & Bamvita, J. M. (2008). Life course social and health conditions linked to frailty in Latin American older men and women. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 63(12), 1399–1406.Google Scholar
Andrew, M. K., Mitnitski, A., Kirkland, S. A., & Rockwood, K. (2012). The impact of social vulnerability on the survival of the fittest older adults. Age and Ageing, 41, 161–165.Google Scholar
Andrew, M. K., Mitnitski, A. B., & Rockwood, K. (2008). Social vulnerability, frailty and mortality in elderly people. PLoS One, 3, e2232.Google Scholar
Avila-Funes, J. A., Helmer, C., Amieva, H., Barberger-Gateau, P., Le, G. M., Ritchie, K., et al. . (2008). Frailty among community-dwelling elderly people in France: The three-city study. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 63, 1089–1096.Google Scholar
Bandeen-Roche, K., Xue, Q. L., Ferrucci, L., Walston, J., Guralnik, J. M., Chaves, P., et al. . (2006). Phenotype of frailty: Characterization in the women’s health and aging studies. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 61, 262–266.Google Scholar
Bergman, H., Ferrucci, L., Guralnik, J., Hogan, D. B., Hummel, S., Karunananthan, S., et al. . (2007). Frailty: An emerging research and clinical paradigm – issues and controversies. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 62, 731–737.CrossRefGoogle ScholarPubMed
Berkman, L. F., & Macintyre, S. (1997). The measurement of social class in health studies: Old measures and new formulations. IARC Scientific Publications, 138, 51–64.Google Scholar
Canadian Study of Heath and Aging (CSHA) Working Group. (1994). Canadian study of health and aging: Study methods and prevalence of dementia. Canadian Medical Association Journal, 150, 899–913.Google Scholar
Cawthon, P. M., Marshall, L. M., Michael, Y., Dam, T. T., Ensrud, K. E., Barrett-Connor, E., et al. . (2007). Frailty in older men: Prevalence, progression, and relationship with mortality. Journal of the American Geriatrics Society, 55, 1216–1223.Google Scholar
Ebrahim, S., Papacosta, O., Wannamethee, G., & Adamson, J. (2004). Social inequalities and disability in older men: Prospective findings from the British regional heart study. Social Science & Medicine, 59, 2109–2120.Google Scholar
Ensrud, K. E., Ewing, S. K., Taylor, B. C., Fink, H. A., Stone, K. L., Cauley, J. A., et al. . (2007). Frailty and risk of falls, fracture, and mortality in older women: The study of osteoporotic fractures. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 62, 744–751.Google Scholar
Faber, M. J., Bosscher, R. J., Chin, A. P. M., & van Wieringen, P. C. (2006). Effects of exercise programs on falls and mobility in frail and pre-frail older adults: A multicenter randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 87, 885–896.Google Scholar
Feinberg, A. W. (2003). Frailty can be curtailed. Vigorous exercise helps, but how practical is it for the elderly? Health News, 9, 4.Google Scholar
Fillenbaum, G. G. (1988). Multidimensional functional assessment of older adults: The duke older Americans resources and services procedures. Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
Fried, L. P., Hadley, E. C., Walston, J. D., Newman, A. B., Guralnik, J. M., Studenski, S., et al. . (2005). From bedside to bench: Research agenda for frailty. Science of Aging Knowledge Environment, 2005(31), pe24.Google Scholar
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., et al. . (2001). Frailty in older adults: Evidence for a phenotype. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 56(3), M146–M156.CrossRefGoogle ScholarPubMed
Galobardes, B., Shaw, M., Lawlor, D. A., Lynch, J. W., & Davey, S. G. (2006a). Indicators of socioeconomic position (part 1). Journal of Epidemiology and Community Health, 60, 7–12.CrossRefGoogle ScholarPubMed
Galobardes, B., Shaw, M., Lawlor, D. A., Lynch, J. W., & Davey, S. G. (2006b). Indicators of socioeconomic position (part 2). Journal of Epidemiology and Community Health, 60, 95–101.Google Scholar
Hogan, D. B., MacKnight, C., & Bergman, H. (2003). Models, definitions, and criteria of frailty. Aging Clinical and Experimental Research, 15, 1–29.Google Scholar
Jones, D., Song, X., Mitnitski, A., & Rockwood, K. (2005). Evaluation of a frailty index based on a comprehensive geriatric assessment in a population based study of elderly Canadians. Aging Clinical and Experimental Research, 17, 465–471.Google Scholar
Jones, D. M., Song, X., & Rockwood, K. (2004). Operationalizing a frailty index from a standardized comprehensive geriatric assessment. Journal of the American Geriatrics Society, 52, 1929–1933.Google Scholar
Klein, B. E., Klein, R., Knudtson, M. D., & Lee, K. E. (2005). Frailty, morbidity and survival. Archives of Gerontology and Geriatrics, 41, 141–149.Google Scholar
Krieger, N., Williams, D. R., & Moss, N. E. (1997). Measuring social class in US public health research: Concepts, methodologies, and guidelines. Annual Review of Public Health, 18, 341–378.Google Scholar
Lang, I. A., Hubbard, R. E., Andrew, M. K., Llewellyn, D. J., Melzer, D., & Rockwood, K. (2009). Neighborhood deprivation, individual socioeconomic status, and frailty in older adults. Journal of the American Geriatrics Society, 57, 1776–1780.Google Scholar
McMunn, A., Nazroo, J., & Breeze, E. (2009). Inequalities in health at older ages: A longitudinal investigation of the onset of illness and survival effects in England. Age and Ageing, 38, 181–187.CrossRefGoogle Scholar
Melis, R. J., van Eijken, M. I., Borm, G. F., Wensing, M., Adang, E., van de Lisdonk, E. H., et al. . (2005). The design of the Dutch EASYcare study: A randomised controlled trial on the effectiveness of a problem-based community intervention model for frail elderly people [NCT00105378]. BMC Health Services Research, 5, 65.Google Scholar
Michalos, A. C. (1980). Satisfaction and happiness. Social Indicators Research, 8, 385–422.Google Scholar
Mitnitski, A. B., Graham, J. E., Mogilner, A. J., & Rockwood, K. (2002). Frailty, fitness and late-life mortality in relation to chronological and biological age. BMC Geriatrics, 2, 1.CrossRefGoogle ScholarPubMed
Mitnitski, A. B., Song, X., & Rockwood, K. (2004). The estimation of relative fitness and frailty in community-dwelling older adults using self-report data. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 59(6), M627–M632.Google Scholar
Newman, A. B., Arnold, A. M., Naydeck, B. L., Fried, L. P., Burke, G. L., Enright, P., et al. . (2003). “Successful aging”: Effect of subclinical cardiovascular disease. Archives of Internal Medicine, 163, 2315–2322.Google Scholar
Newman, A. B., Gottdiener, J. S., McBurnie, M. A., Hirsch, C. H., Kop, W. J., Tracy, R., et al. . (2001). Associations of subclinical cardiovascular disease with frailty. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 56, M158–M166.CrossRefGoogle ScholarPubMed
Ostir, G. V., Ottenbacher, K. J., & Markides, K. S. (2004). Onset of frailty in older adults and the protective role of positive affect. Psychological Aging, 19, 402–408.Google Scholar
Ramsay, S. E., Whincup, P. H., Morris, R. W., Lennon, L. T., & Wannamethee, S. G. (2008). Extent of social inequalities in disability in the elderly: Results from a population-based study of British men. Annals of Epidemiology, 18(12), 896–903.Google Scholar
Rautio, N., Adamson, J., Heikkinen, E., & Ebrahim, S. (2006). Associations of socio-economic position and disability among older women in Britain and Jyvaskyla, Finland. Archives of Gerontology and Geriatrics, 42, 141–155.Google Scholar
Rautio, N., Heikkinen, E., & Ebrahim, S. (2005). Socio-economic position and its relationship to physical capacity among elderly people living in Jyvaskyla, Finland: Five- and ten-year follow-up studies. Social Science & Medicine, 60, 2405–2416.Google Scholar
Rockwood, K. (2005). What would make a definition of frailty successful? Age and Ageing, 34, 432–434.Google Scholar
Rockwood, K., Fox, R. A., Stolee, P., Robertson, D., & Beattie, B. L. (1994). Frailty in elderly people: An evolving concept. Canadian Medical Association Journal, 150, 489–495.Google Scholar
Rockwood, K., Hogan, D. B., & MacKnight, C. (2000). Conceptualisation and measurement of frailty in elderly people. Drugs and Aging, 17(4), 295–302.Google Scholar
Rockwood, K. & Mitnitski, A. (2007). Frailty in relation to the accumulation of deficits. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 62, 722–727.Google Scholar
Rockwood, K., Mitnitski, A., Song, X., Steen, B., & Skoog, I. (2006). Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70. Journal of the American Geriatrics Society, 54, 975–979.Google Scholar
Rockwood, K., Stadnyk, K., MacKnight, C., McDowell, I., Hebert, R., & Hogan, D. B. (1999). A brief clinical instrument to classify frailty in elderly people. The Lancet, 353, 205–206.Google Scholar
Singh-Manoux, A., Marmot, M. G., & Adler, N. E. (2005). Does subjective social status predict health and change in health status better than objective status? Psychosomatic Medicine, 67(6), 855–861.Google Scholar
Statistics Canada. (1992). Profile of census metropolitan areas and census agglomerations, 1991 census – 100% data. Ottawa, ON: Ministry of Industry, Science and Technology.Google Scholar
Szanton, S. L., Seplaki, C. L., Thorpe, R. J. Jr., Allen, J. K., & Fried, L. P. (2010). Socioeconomic status is associated with frailty: The Women’s Health and Aging Studies. Journal of Epidemiology and Community Health, 64, 63–67.Google Scholar
Taylor, M. G. (2010). Capturing transitions and trajectories: The role of socioeconomic status in later life disability. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 65, 733–743.Google Scholar
Teng, E. L., & Chui, H. C. (1987). The Modified Mini-Mental State (3MS) examination. The Journal of Clinical Psychiatry, 48, 314–318.Google Scholar
van Kippersluis, H., O’Donnell, O., van Doorslaer, E., & van Ourti, T. (2010). Socioeconomic differences in health over the life cycle in an Egalitarian country. Social Science & Medicine, 70, 428–438.Google Scholar