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Education, wealth, and duration of life expected in various degrees of frailty

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Abstract

Multistate life tables are used to estimate life expected in three frailty states: frailty free, mild/moderate frailty, severe frailty. Estimates are provided for the combination of education and wealth by age, stratified by sex. Data consider 17,115 cases from the Health and Retirement Study, 2000–2014. Frailty is measured using a 59 item frailty index based on deficit accumulation. Estimates are derived using stochastic population analysis for complex events. Population-based and status-based results are reported. Findings confirm a hypothesis that the combination of higher education and wealth results in longer lives in more favorable degrees of frailty. Also, as hypothesized, wealth generally affords a greater advantage than does education among those with severe frailty at baseline. For instance, high wealth provides a 70-year-old woman with severe frailty at baseline 0.70 more total years and 0.81 more frailty free years then her counterpart with low wealth, compared to gains of 0.39 and 0.54, respectively, for those with high education. Unexpectedly, wealth also has a greater role among those frailty free at baseline. A 70-year-old woman frailty free at baseline with high wealth lives 3.19 more net years and 4.13 more years frailty free than her counterpart with low wealth, while the same comparison for high versus low education indicates advantages of 2.00 total and 1.96 frailty free years. Relative change ratios also indicate more robust results for wealth versus education. In sum, there is evidence that inequality in duration of life in degrees of frailty is socially patterned.

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Acknowledgements

The lead author acknowledges funding from the Social Sciences and Humanities Research Council of Canada and their Canada Research Chairs program.

Funding

The lead author acknowledges funding from the Social Sciences and Humanities Research Council of Canada and their Canada Research Chairs program. The Health and Retirement Study receives funding from United States Department of Health and Human Services. National Institutes of Health. National Institute on Aging (NIA U01AG009740), United States Social Security Administration.

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Authors and Affiliations

  1. Global Aging and Community Initiative and Department of Family Studies and Gerontology, Mount Saint Vincent University, 166 Bedford Highway, McCain Centre 201C, Halifax, NS, B3M2J6, Canada

    Zachary Zimmer

  2. College of Economic and Population Research Institute, Nihon University, Chiyoda City, Japan

    Yasuhiko Saito

  3. School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, Canada

    Olga Theou

  4. Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Canada

    Olga Theou, Clove Haviva & Kenneth Rockwood

Authors
  1. Zachary Zimmer
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  2. Yasuhiko Saito
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  3. Olga Theou
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  4. Clove Haviva
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  5. Kenneth Rockwood
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Contributions

ZZ conceptualized the paper, conducted the analysis and wrote the first draft. YS conducted the analysis and contributed to writing of the methodology section. OT edited the manuscript and consulted on conceptualization and interpretation. CH edited the manuscript, conducted statistical analysis and construction of variables and consulted on interpretation and development of indicators. KR edited the manuscript and consulted on the conceptualization and interpretation.

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Correspondence to Zachary Zimmer.

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Through Dalhousie University, KR has asserted copyright of the Clinical Frailty Scale. It is free for use for education, research and not-for-profit care.

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Zimmer, Z., Saito, Y., Theou, O. et al. Education, wealth, and duration of life expected in various degrees of frailty. Eur J Ageing 18, 393–404 (2021). https://doi.org/10.1007/s10433-020-00587-2

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