Abstract

Physical frailty in older people is an escalating health and social challenge. We investigate its physical, psychological, and social predictors, including how and for whom these conditions exert their effects. For 4638 respondents aged 65–89 years from wave 2 of the English Longitudinal Study of Ageing, we examine prediction of future physical frailty by physical, psychological, and social conditions using latent growth curve analysis with multiple indicators. In addition, we explore their indirect effects through disease and physiologic decline, and repeat these analyses after stratification by gender, age group, and selected conditions which are possible moderators. We find that chronic disease, allostatic load, low physical activity, depressive symptoms, cognitive impairment, and poor social support all predict future physical frailty. Furthermore, chronic disease and allostatic load mediate the effects of low physical activity, depressive symptoms, and cognitive impairment on future physical frailty. Finally, although poor social integration is not a predictor of future physical frailty, this condition moderates the indirect effect of poor social support through chronic disease by rendering it stronger. By virtue of their roles as predictor, mediator, or moderator on pathways to physical frailty, chronic disease, allostatic load, low physical activity, cognitive impairment, depressive symptoms, poor social support, and poor social integration are potentially modifiable target conditions for population-level health and social interventions to reduce future physical frailty in older people.

Highlights

  • BackgroundFrailty denotes the multidimensional loss of an individual’s reserves that occurs with greater probability with advancing age, and results in vulnerability to developing adverse outcomes (Lally and Crome 2007)

  • We find that chronic disease, allostatic load, low physical activity, depressive symptoms, cognitive impairment, and poor social support all predict future physical frailty

  • The second part is the regression of physical frailty factors at waves 2, 4, and 6 on their lagged time-varying predictors, namely chronic disease, allostatic load, low physical activity, depressive symptoms, cognitive impairment, poor social support, and poor social integration measured at waves 1, 2, and 4 respectively

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Summary

Background

Frailty denotes the multidimensional loss of an individual’s reserves that occurs with greater probability with advancing age, and results in vulnerability to developing adverse outcomes (Lally and Crome 2007). Their effects are mediated by disease and physiologic reserve decline. This framework offers a useful starting point for assembling a set of predictors on pathways to physical frailty in older people. We examine the roles of key conditions in moderating the effects of other conditions and in mediating indirect effects To this end, we will operationalize the aforementioned physical frailty specification with three indicators and use it in the analysis of panel data of older people from the English Longitudinal Study of Ageing (ELSA). It offers a broad range of reliable and multidimensional data across biennial waves beginning from 2002

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