Survey On Health , Ageing And Retirement In Europe Research Articles

Depends on whom you ask: Discordance in reporting spousal care between older women and men across European welfare states

PurposeWe aim to investigate systematic differences in reporting spousal care between caregivers and cared-for persons and their possible effects for the analysis of care regimes and correlation of care with health. Materials and methodsUsing information on care provided/received from the Survey on Health, Ageing and Retirement in Europe (SHARE), we estimate the prevalence of spousal care and discordance between caregivers and cared-for persons in the reporting of care among caregiving dyads. Multinomial regressions are used to estimate systematic differences in reporting spousal care. We then use multivariable logistic regressions to assess the association between discordance in reporting informal care and carer's self-rated health (SRH) and depression using the EURO-D scale. ResultsOnly 53.9 % of dyads report care that is confirmed by both spouses. Multinomial regressions show that agreement on care being provided/received is more common when women are caregivers, while men are likely to underreport when providing or receiving personal care. Prevalence of spousal care across care regimes is sensitive to who reports care. There is no effect on the association of care with SRH regardless of who identifies the carer, while the magnitude and statistical significance of the association between depression symptoms and care varies according to the choice of respondent. ConclusionsInformal care may be understated across Europe when relying solely on carer self-identification through description of tasks in surveys. From a policy standpoint, relying on self-identification of carers to access support or social benefits may potentially reduce the take-up of such benefits or support.

El estado de salud de la población en edad de jubilación: una primera aproximación

RationaleThe health of the population aged 55 to 69 influences their labour supply and retirement decisions. This article aims to document their health status, in Spain and in other European countries, drawing on data from the Survey on Health, Ageing and Retirement in Europe (SHARE).Takeaways•There are marked differences by gender in the health status of the Spanish population aged 65 to 69. Among women, 62.9% report chronic health problems, 30.1% mobility limitations and 32.1% depression-related symptoms, compared with 53.3%, 15.8% and 16.3%, respectively, among men. These prevalences are significantly higher in the 65 to 69 age group than in the 55 to 64 age group.•However, there were some improvements in the incidence of health problems between cohorts in these age groups. For instance, the prevalence of chronic diseases and of mobility limitations among women aged 55 to 64 was lower in 2015 than in 2004.•In comparison with other European countries, in Spain the prevalence of the three health indicators considered is high among women between 65 and 69. Moreover, Spain is one of the countries with the highest increases in health problems in the 65 to 69 age group compared with the 55 to 64 age group.

Predictors of long-term care use - informal home care recipients versus private and public facilities residents in Poland

BackgroundThe population aging, together with the shrinking caring potential of families, is a major challenge for social policy in the coming years. The aim of the study is to identify the factors that determine not only the use of long-term care (LTC) but also the selection of individual types of such care in Poland.MethodsUsing unique data collected from inpatient LTC facilities in Poland and the Survey on Health, Ageing and Retirement in Europe (SHARE) database, we estimate logistic regressions explaining the choice of LTC solution.ResultsOur results suggest that social inequalities play a role in choosing the type of LTC. Better educated people choose private institutions, while people without support network use more often social residential homes. The impact of multimorbidity on choosing different types of inpatient facilities is limited, thus the number of ADL limitations remains a better indicator of long term care utilization.ConclusionsThe study confirms that social inequalities influence decisions about the choice of LTC. However, multi-morbidity is a predictor of using LTC to a limited extent. The differences in LTC selection determinants between women and men are noticeable.

The effect of COVID-19 confinement and economic support measures on the mental health of older population in Europe and Israel

This study focuses on the impact of confinement and economic support measures on the mental health of the older population (aged 50 and above) across twenty-five European countries and Israel. While studies evaluating the effect of confinement measures on mental health exist, they largely ignore the potentially offsetting effects of economic support measures. Moreover, previous findings on the effect of confinement measures are inconsistent, and many studies are based solely on cross-sectional designs. Using data from the Corona Survey wave (2020) of the Survey on Health, Ageing and Retirement in Europe (SHARE), we leverage the date of interview information to vary individual exposure to different policy contexts within countries. Overall, we do not find support for the negative effect of confinement measures on older adults’ mental health. If anything, both confinement and support measures worked in tandem to soothe mental distress, resulting from the pandemic. The confinement effects, however, are contingent on age, potentially indicating that younger people are more likely to be negatively affected by lockdowns.

Long-term care costs and obesity - projections for Poland

The share of both elderly and obese people in the population of many countries, including Poland in particular, will increase. The aim of the study is to investigate the impact of obesity of adults 50+ on public expenditures on long-term care in Poland. Using the Survey on Health Ageing and Retirement in Europe (SHARE) database and the European Commission macro-simulation model, we estimate long-term projection of long-term care costs of older adults depending on the level of obesity. Our results suggest that obese people are more likely to be disabled and obesity of adults 50+ may increase the long-term care costs by up to 0.3% of GDP in 2070 horizon.

Exclusion from social relations in later life: on the gendered associations of social networks with mental wellbeing

Objectives: This study addresses the gendered risks of loneliness and depression in later life from a social exclusion perspective. Exclusion from social relations (ESR) in older age is an unwanted situation associated with increased loneliness and depressive symptoms, with gender differences in the perception of solitude, and the evaluation of existing social networks, potentially accounting for the increased susceptibility of older women. Method: Secondary analyses was conducted in a sample of 60,918 participants in the Survey on Health, Aging and Retirement in Europe (SHARE). Older persons’ subjective perception of solitude (i.e. solitude satisfaction), and their satisfaction with established relations (i.e. network satisfaction), were examined in gender-stratified regression models, predicting loneliness and depressive symptomatology, controlling for network size, demographics, and health. Results: There was no convincing evidence for significant associations between solitude satisfaction (SoS) and loneliness among older men, nor between network satisfaction (NeS) and loneliness for both genders. Low SoS and low NeS were independently associated with more depressive symptoms and an increased probability of depression, especially among older women. This vulnerability could not be attributed to increased loneliness, as only among older women, low SoS was associated with lower levels of loneliness, and lower levels of loneliness was anaemically associated with more depressive symptoms. Conclusions: The perception of solitude, and the evaluation of social relations, are associated with gendered risks of depression among older persons who are challenged by objective and subjective ESR states.

Older adults, cognitively stimulating activities and change in cognitive function

ABSTRACT Finding interventions which can address the decline of cognitive function as people get older is of great importance to policy-makers, especially in post-industrial societies with rapidly ageing populations. We examine the impact of several different types of mentally stimulating activities on cognitive function in a sample of community-dwelling Europeans aged 50 and older. The data were drawn from the fourth, fifth and sixth waves of the Survey on Health, Ageing and Retirement in Europe (SHARE). The activities analysed include non-formal learning activities such as education and training courses; informal learning activities such as reading books, newspapers and magazines; and some other types of cognitively stimulating activities including crossword puzzles and playing chess or card games. The cognitive function outcomes under investigation were memory and verbal fluency. Our longitudinal analysis of data on these older adults show that all the activities constituted a potential source for the delay or reduction of cognitive decline, even after a short period – only 4 years – of engagement in such activities and regardless of their age.

Network and solitude satisfaction as modifiers of disadvantages in the quality of life of older persons who are challenged by exclusion from social relations: a gender stratified analysis

This study examined from a gender-sensitive perspective the associations of exclusion from social relations (ESR) with the quality of life (QoL) of excluded older persons. Being satisfied with existing relations (i.e., network satisfaction) may be particularly important for the QoL of older persons with small networks, whereas the QoL of “network-less” older persons may be associated with their perception of solitude (i.e., solitude satisfaction). This study examined the moderating role of network satisfaction (NS) in the gendered associations between network size and QoL, as well as the gendered associations of solitude satisfaction (SS) with the QoL of older “network-less” persons. In addition, the comparative disadvantages in the QoL of “network-less” older persons with low-to-high SS, compared to the QoL of socially embedded persons with low-to-high NS were examined. Cross-sectional gender stratified secondary analyses of data from participants (N = 72.433) in the Survey on Health, Aging and Retirement in Europe (SHARE) did not provide convincing evidence that a higher NS is particularly important for the QoL of older persons with smaller networks. Among older “network-less” persons, lower SS was associated with lower QoL, comparatively more so among older women. Older persons embedded in a social network with low NS, as well as older “network-less” persons with low SS, have comparatively the lowest levels of QoL. It was concluded that the subjective evaluation of social relations and the subjective evaluation of solitude are associated with gendered disadvantages in the QoL of older persons challenged by ESR.

COVID-19 and Unmet Healthcare Needs of Older People: Did Inequity Arise in Europe?

Background: The disruption in healthcare provision due to the COVID-19 pandemic forced many non-urgent medical treatments and appointments to be postponed or denied, which is expected to have huge impact on non-acute health conditions, especially in vulnerable populations such as older people. Attention should be paid to equity issues related to unmet needs during the pandemic. Methods: We calculated concentration indices to identify income-related inequalities and horizontal inequity in unmet needs due to postponed and denied healthcare in people over 50 during COVID-19, using data from the Survey on Health, Ageing and Retirement in Europe (SHARE). Results: Very few countries show significant income-related inequalities in postponed, rescheduled or denied treatments and medical appointments, usually favouring the rich. Only Estonia, Italy and Romania show a significant horizontal inequity (HI) in postponed healthcare, which apparently favours the poor. Significant pro-rich inequity in denied healthcare is found in Italy, Poland and Greece. Conclusions: Although important income-related horizontal inequity in unmet needs of European older adults during the early waves of the COVID-19 pandemic is not evident for most countries, some of them have to carefully monitor barriers to healthcare access. Delays in diagnosis and treatments may ultimately translate into adverse health outcomes, reduced quality of life and, even, widen socio-economic health inequalities among older people.

The EURO-D Measure of Depressive Symptoms in the Aging Population: Comparability Across European Countries and Israel

Most of the countries in Europe are experiencing a rapid aging of their populations and with this an increase in mental health challenges due to aging. Comparative research may help countries to assess the promotion of healthy aging in general, and mentally healthy aging in particular, and explore ways for adapting mental health policy measures. However, the comparative study of mental health indicators requires that the groups understand the survey questions inquiring about their mental health in the same way and display similar response patterns. Otherwise, observed differences in perceived mental health may not reflect true differences but rather cultural bias in the health measures. To date, research on cross-country equivalence of depression measures among older populations has received very limited attention. Thus, there is a growing need for the cross-country validation of existing depression measures using samples of the older population and establishing measurement equivalence of the assessment tools. Indeed, insights on mental health outcomes and how they compare across societies is paramount to inform policy makers seeking to improve mental health conditions of the populations. This study, therefore, aims to examine measurement equivalence of self-reported depressive symptoms among older populations in 17 European countries and Israel. The data for the current analysis are from the sixth wave (2015) of the Survey on Health, Ageing and Retirement in Europe (SHARE) and consist of the population of respondents 50 years of age and older. The measurement of depression is based on the EURO-D scale, which was developed by a European consortium. It identifies existing depressive symptoms and consists of the 12 items: depression, pessimism, suicidality, guilt, sleep, interest, irritability, appetite, fatigue, concentration, enjoyment, and tearfulness. We examine the cross-country comparability of these data by testing for measurement equivalence using multigroup confirmatory factor analysis (MGCFA) and alignment. Our findings reveal partial equivalence thus allowing us to draw meaningful conclusions on similarities and differences among the older population across 18 countries on the EURO-D measure of depression. Findings are discussed in light of policy implications for universal access to mental health care across countries.

Non-Financial Support Provided to Parents in Stepfamilies: Empirical Examination of Europeans 50.

The aging of the population, coupled with increasing divorce and remarriage rates, are changing the structure of potential non-financial support for older parents. The purpose of this study was to examine support provided to parents aged 50+ in stepfamilies and to determine if the difference existed between help provided by natural children and stepchildren. The primary objective was to investigate whether blood ties were a significant determinant of the support if the quality of the relationship between the parent and a natural child or a stepchild was taken into account. The secondary objective was to answer the question to what extent the reciprocal exchange motive of support was observed in stepfamilies. The probability of non-financial support from children and stepchildren was estimated based on the sixth wave of the SHARE (Survey on Health, Ageing, and Retirement in Europe) database for European countries. Children in stepfamilies provided less non-financial help to parents than those in intact families. Stepchildren were less likely to be in stepparents’ social networks, and stepparents provided less help with childcare for grandchildren than they did to their biological children. Relationship closeness and looking after grandchildren increased the probability of non-financial support to older parents, regardless of whether the donor was a natural child or a stepchild.

Childlessness, geographical proximity and non-family support in 12 European countries

AbstractThe number of relatives and geographical proximity between them affects informal support provided to older persons. In this study, we investigate whether (a) childless persons and parents living remotely from their adult children experience similar shortages in informal support, and (b) whether neighbours, friends and other non-family helpers compensate for these shortages. On the basis of Survey on Health, Ageing and Retirement in Europe (SHARE) data for 12 European countries, we estimate the probability and amount of informal non-financial support received by persons aged 65 and over who remain childless or live at different distances to their children. The contribution of non-family individuals is rather complementary to the help from family. Parents residing in the proximity of their children rely almost exclusively on family; as the geographical distance between adult children and older parents increases, the probability and amount of non-family support increase as well. But childless individuals differ from parents of remotely living children: the former rely on smaller support networks and resort more often to other relatives than the latter. Non-family individuals compensate for the scarcity of informal support only in the case of parents of distant children, but not in the case of childless individuals.

Quality of Life, Health and the Great Recession in Spain: Why Older People Matter?

The financial crisis of 2008 precipitated the “Great Recession”. In this scenario, we took Spain as a country of study, because although it experienced significant negative shocks associated with macroeconomic variables (GDP or unemployment), its welfare indicators have been marked by limited changes. This study used data from waves 2 and 4 (years 2006–2007 and 2010–2012, respectively) of the Survey on Health, Aging and Retirement in Europe (SHARE). Specifically, through logistic regressions we have analysed the effects of socioeconomic, demographic, health and “Great Recession” factors on the quality of life (QoL) of elders in Spain. Although QoL did not change too much during the “Great Recession”, the results confirmed the importance of several factors (such as chronicity) that affect the satisfaction with the QoL among the older people. In this regard, statistically significant effects were obtained for individual exposure to recession. Therefore, a decrease in household income in the crisis period with respect to the pre-crisis period would increase by 44% the probability of reporting a low QoL (OR = 1.44; 95% CI: 1.00–2.07). Furthermore, gender differences were observed. Health and socioeconomic variables are the most significant when determining individual QoL. Therefore, when creating policies, establishing multidisciplinary collaborations is essential.

Aging and Gender Health Gap: A Multilevel Analysis for 17 European Countries

The European population is aging and their declining capacity makes older Europeans more dependent on the availability of care. Male and female health needs at older ages are different, yet there are contradictory results on the study of gender inequalities in health among the older European population. The aim of this article is twofold: first, we study whether there is a general gender health gap at older ages across Europe. Secondly, we analyze the existence of an increasing or decreasing universal association between the gender health gap and age among the older European population or whether, by contrast, this depends on the type of welfare state. To achieve these goals, we use data from the Survey on Health, Ageing and Retirement in Europe (SHARE) for respondents aged 50 and over in 2015, and we carry out several multilevel random intercept logistic regressions for European countries. Our results show that when we split European countries into groups according to the type of welfare state, we only find a significant gender health gap in older people in Southern and Social Democratic countries. Some differences have been found in the links between the gender health gap and age among European countries. Old women report worse health than men at all ages in Southern countries while in Social Democratic states it is only true for women aged 80 and over. In Bismarckian states there are barely any gender differences, while the gender health gap has no clearly defined bias. Between the ages of 60 and 79, men from Eastern European countries report poorer health, while after 80 it is women who report poorer health. In general, we found the widest gender inequalities in health for the oldest population group, especially in Southern and Eastern European countries.

The dynamics of frailty and change in socio-economic conditions: evidence for the 65+ in Europe.

The frailty phenotype for older people is defined as an increased vulnerability to stressors, leading to adverse health outcomes. It is acknowledged as a specific precursor of disability besides chronic diseases that allows for some reversibility in the loss of autonomy. Although the literature on the socio-economic determinants of frailty is emerging in cross-sectional settings, little is known about the dynamics of this relationship over time. This article examines the joint evolution of frailty and change in economic conditions for the 65+ in Europe. Individual and longitudinal data from SHARE (Survey on Health, Ageing and Retirement in Europe) over the period 2004-12 has been used. The sample contains 31044 observations from 12002 respondents aged 65 or more. A fixed effect Poisson model is estimated in order to control for unobserved individual heterogeneity. Three types of explanative economic variables have been considered in turn: income, wealth and a subjective variable of deprivation. Our results indicate that individuals with worsening economic conditions (wealth and subjective deprivation) over time simultaneously experience a rapid increase in the frailty symptoms. Results also show that the nature of economic variable does not affect the frailty process in the same way. Subjective measure of deprivation seems to better evaluate the household's financial difficulties than objective measure. From a public policy perspective, these results show that policies fostering economic conditions of the elderly could have a significant impact on frailty and henceforth, could reduce the risks of disability.

Macro-level determinants of post-retirement health and health inequalities: A multilevel analysis of 18 European countries

Poor health after retirement may have an important economic and societal impact and may be affected by macro-level factors. Our aim was to examine whether macro-level factors are associated with health and educational differences in health in recent retirees. We used data covering 18 European countries from the Survey on Health, Ageing and Retirement in Europe (SHARE) and the English Longitudinal Study of Ageing (ELSA) on 8867 respondents who had been retired less than 5 years. We performed multi-level linear regression analyses to examine whether social expenditure in nine policy areas, minimum pension replacement rates, and unemployment replacement rates explained cross-country differences in post-retirement self-rated health (SRH) and educational inequalities in SRH. In both men and women, a higher total expenditure as well as higher expenditures on health, old age, housing, and ‘other social policy areas’ (non-categorical cash benefits to low-income households and other social services) were associated with better SRH. Cross-level interactions showed that in the presence of a higher old age expenditure, a higher unemployment expenditure, and a higher total expenditure, the absolute educational inequalities in post-retirement SRH were smaller than with lower expenditures in these areas, in both men and women. We found the same effect in women only for a higher expenditure on health as well as a higher minimum pension replacement rate. A higher expenditure on survivors pensions, a lower expenditure on family, and a higher unemployment replacement rate had this effect in men only. This study showed that social expenditure and replacement rates were associated with post-retirement health and health inequalities.

NINE YEAR CHANGES IN PREVALENCE OF COGNITIVE IMPAIRMENT IN THE CZECH REPUBLIC

Studies from North America and Western Europe suggest stable or declining trends in impaired cognition. Nevertheless, data on changes in cognitive health from Central and Eastern Europe are largely lacking. Therefore, we aimed to examine changes in the age-specific prevalence of cognitive impairment in the Czech Republic, a country in Central Europe. To this aim we used two samples from the population-based Czech Survey on Health, Ageing and Retirement in Europe (SHARE). Age-specific prevalence of cognitive impairment (defined based on scores in verbal fluency, immediate recall, delayed recall and temporal orientation) was compared between participants in wave 2 (2006/2007; n=1,107) and wave 6 (2015; n=3,104). Logistic regression was used to estimate the association between wave and cognitive impairment, step-wise adjusting for sociodemographic and clinical characteristics. Multiple sensitivity analyses, focusing on alternative operationalisations of relative cognitive impairment, impact of missing cognitive data and survival bias, were carried out. The most conservative estimate suggested that the age-specific prevalence of cognitive impairment declined by one fifth, from 11% in 2006/2007 to 9% in 2015. Decline was observed in all sensitivity analyses. Multivariate decomposition for nonlinear models was used to examine which predictors explain the change in prevalence. Reduction in physical inactivity, control of high blood cholesterol and increases in length of education were the main predictors contributing to decline in cognitive impairment. In conclusion, our findings are in line with those found in North America and Western Europe even though countries in Central and Eastern Europe, including Czech Republic, have poorer risk profiles.

Frailty as predictor for all-cause and cause-specific mortality: 11-year follow-up cohort study

Abstract Background Frailty is a geriatric syndrome characterised by sarcopenia, malnutrition, and chronic inflammation that leads to adverse health outcomes including dependency, low quality of life, and higher risk for morbidity and mortality. It was the aim of this study to examine the relationship between frailty status and risk of all-cause and cause-specific mortality. Methods The study is based on data from the Survey on Health, Aging and Retirement in Europe (SHARE) including 11 European countries with an 11-year follow up. 24,634 participants with a mean age of 64.2 (9.8) 53.6% female, were analysed. Frailty status was calculated using the SHARE- Frailty Instrument, categorizing the participants as robust, pre-frail, and frail. Cox Proportional Hazard models were used to estimate the risk of all-cause and cause-specific (stroke, heart attack, other cardiovascular disease, cancer, respiratory illness, infectious, digestive and other) mortality in frail and pre-frail subjects compared to robust persons. Results 14.7% and 6.9% were found to be pre-frail or frail at the baseline. During the follow-up, we observed both pre-frailty and frailty being associated with a higher risk of all-cause and cause-specific mortality in the unadjusted model. After adjusting for sex, age, education level, body mass index, smoking, alcohol consumption and a number of comorbidities, frailty was associated with a higher risk of all-cause mortality [HR 1.56 (95% CI 1.37-1.78)], and mortality due to other cardiovascular diseases [HR 1.88 (95% CI 1.27-2.76)], cancer [HR 1.47 (95% CI 1.14-1.90)], and respiratory disease HR [1.82 (95% CI 1.10-3.01)]. Furthermore, pre-frailty was associated with a higher risk of all-cause mortality [HR 1.27 (95% CI 1.14-1.42)] and other cardiovascular disease mortality [HR 1.70 (95% CI 1.22-2.35)]. Conclusions Our study showed that baseline pre-frailty and frailty are associated with increased all-cause and cause-specific mortality over an 11-year follow up. Key messages Frailty but also pre-frailty leads to a higher mortality, even when adjusted for morbidity, lifestyle factors, and socio-demographic factors. More effort is needed to prevent, detect, and treat frailty and pre-frailty, both, on individual and on community level.

Educational differences in macro-level determinants of early exit from paid work: a multilevel analysis of 14 European countries

The aim of this study was to identify macro-level determinants of early work exit and investigate whether the effects of these determinants differ across educational groups. We used data from the Survey on Health, Ageing and Retirement in Europe (SHARE) (2011–2013) and the English Longitudinal Study of Ageing (ELSA) (2010/2011–2012/2013) as well as macro-level data and included 10,584 participants in 14 European countries. We used logistic multilevel analyses to examine educational differences in macro-level determinants of early work exit. Macro-level determinants were: minimum unemployment replacement rates, expenditure on active labour market policies (aimed to help the unemployed find work) and passive labour market policies (unemployment and early retirement benefits), employment protection legislation (costs involved in dismissing individuals), unemployment rates, statutory pension age and implicit tax on continued work. We found low-educated workers to be more at risk of early work exit than higher educated workers. In low-educated men, higher unemployment replacement rates, higher expenditure on passive labour market policies, stricter employment protection legislation and a higher implicit tax on continued work were associated with a higher risk of early work exit, whereas no macro-level factors were associated with early work exit in highly educated men. In women, a higher expenditure on passive labour market policies and a higher implicit tax on continued work were determinants of early work exit, regardless of educational level. To conclude, low-educated men seem to be especially responsive to the effects of pull factors that make early retirement financially more attractive.

Frailty Status Predicts All-Cause and Cause-Specific Mortality in Community Dwelling Older Adults

ObjectivesTo examine the relationship between frailty status and risk of all-cause and cause-specific mortality. DesignLongitudinal cohort study with an 11-year follow up. Setting and participantsData from the Survey on Health, Aging and Retirement in Europe (SHARE) were used. In the analysis, we included data from 11 European countries. We included men and women older than 50 years residing in Europe. Overall, 24,634 participants were analyzed with a mean age of 64.2 (9.8), 53.6% female, where 14.7% and 6.9% were found to be prefrail or frail, respectively, at the baseline. MethodsFrailty status was calculated using the SHARE–Frailty Instrument, categorizing the participants as robust, prefrail, and frail. Multivariate Cox regression models were used to estimate the risk of all-cause and cause-specific (stroke, heart attack, other cardiovascular disease, cancer, respiratory illness, infectious, and digestive and other) mortality. ResultsDuring the follow-up, and after adjusting for sex, age, education, body mass index, smoking, alcohol consumption, and number of comorbidities, frailty was associated with a higher risk of all-cause (HR 2.17, 95% CI 1.90-2.48) and mortality due to stroke (HR 2.06, 95% CI 1.37-3.10), heart attack (HR 1.67, 95% CI 1.19-2.34), other cardiovascular disease (HR 2.77, 95% CI 1.87-4.12), cancer (HR 2.11, 95% CI 1.63-2.73), respiratory disease (HR 2.76, 95% CI 1.66-4.60), infectious diseases (HR 1.79, 95% CI 1.03-3.11), and digestive and other causes (HR 2.02, 95% CI 1.51-2.71). Prefrailty was associated with a higher risk of all-cause (HR 1.47, 95% CI 1.31-1.63), heart attack (HR 1.31, 95% CI 1.01-1.72), other cardiovascular disease (HR 2.03, 95% CI 1.46-2.81), respiratory disease (HR 1.70, 95% CI 1.09-2.65), and digestive and other causes (HR 1.50, 95% CI 1.18-1.91) mortality. Conclusions and implicationsBaseline prefrailty and frailty are associated with increased all-cause and cause-specific mortality over an 11-year follow up. Public health policy should include preventive programs aimed at older adults to prevent frailty and reduce mortality.