Is social vulnerability a risk factor for frailty in community-dwelling older people in England? a secondary data analysis of the English Longitudinal Study of Ageing (ELSA)
- Ayodele Ayeni(Author),
- Adrienne Sharples(Supervisor),
- David Hewson(Second supervisor)
Student Thesis:
Student thesis
Doctoral thesis
About the thesis
Background: Social vulnerability (SV) is linked to poor health outcomes including frailty, both of which are associated with adverse consequences such as falls, prolonged hospitalisation and even premature death. However, research to date has not studied any causal relationship, since most studies have been cross-sectional. In addition, there have been no published studies in the UK. The aims of this thesis are to examine associations between social vulnerability and frailty by synthesising evidence from the literature on the relationship between social vulnerability and frailty, constructing a Social Vulnerability Index (SVI) to examine the prevalence of social vulnerability among community-dwelling older people in England and to investigate whether social vulnerability is a risk factor for frailty in community-dwelling older people in England.
Methods: This study conducted a systematic review of the relationship between social vulnerability and frailty, which was then followed by a secondary data analysis (cross-sectional and longitudinal studies) to investigate the correlational and causal relationship between social vulnerability and frailty among community-dwelling older people in England. Data were used from the English Longitudinal Study of Ageing (ELSA), which is a nationally representative panel sample of community-dwelling individuals aged 50 years and over in England. This study analysed data from Waves 2, 4, 6 and 8, with an SVI consisting of 20 items developed. The primary outcome measure was frailty over 12 years of follow-up, with frailty measured using both a Frailty Index (FI) of 59 health deficits and the Frailty Phenotype (FP), both of which were adapted from previous frailty research in ELSA. The longitudinal study examined frailty at follow-up based on social vulnerability status at baseline, after removing participants who were already vulnerable.
Results: The findings of the systematic review showed that SVI varied depending on the country in which the study was carried out, with limited longitudinal studies identified to establish any causal relationship. None of the studies found were from the UK. The cross-sectional study found that SVI consistently had a mean of around 0.35, across all waves, which was similar to values reported in Europe and North America. Social vulnerability and frailty were also found to be moderately correlated, again with similar values to those reported previously. Higher mean scores of SV were observed among female (0.34) than male (0.29). Social vulnerability increased with age except a slight decline in ages 60–69 years.
The longitudinal study found that among non-frail participants who were not socially vulnerable at baseline, frailty was rare at follow-up. At higher levels of social vulnerability, significant associations were found. The odds of moderately socially vulnerable people becoming frail had consistent odds of 1.91–2.21, with the highest odds observed for people who were socially vulnerable, with odds from 4.06–6.08 for the last two follow-up periods.
Conclusions: This study was the first to examine SV in England. The key finding was that, in the absence of frailty at baseline, individuals who were socially vulnerable were more likely to become frail than those who were not vulnerable. It would be worthwhile developing a screening programme using an SVI in primary care to identify SV. This could be followed by evidence-based interventions, such as social prescribing and care navigation, in order to reduce social vulnerability and prevent future frailty in community-dwelling older people in England. The use of an SVI for health assessment could be incorporated into the community-based nursing, the NHS long-term plan and person-centred policy in the NHS for early detection of socially vulnerable individuals who could progress to develop frailty in later years. Further research is needed to develop and validate an SVI for use in primary care.
Methods: This study conducted a systematic review of the relationship between social vulnerability and frailty, which was then followed by a secondary data analysis (cross-sectional and longitudinal studies) to investigate the correlational and causal relationship between social vulnerability and frailty among community-dwelling older people in England. Data were used from the English Longitudinal Study of Ageing (ELSA), which is a nationally representative panel sample of community-dwelling individuals aged 50 years and over in England. This study analysed data from Waves 2, 4, 6 and 8, with an SVI consisting of 20 items developed. The primary outcome measure was frailty over 12 years of follow-up, with frailty measured using both a Frailty Index (FI) of 59 health deficits and the Frailty Phenotype (FP), both of which were adapted from previous frailty research in ELSA. The longitudinal study examined frailty at follow-up based on social vulnerability status at baseline, after removing participants who were already vulnerable.
Results: The findings of the systematic review showed that SVI varied depending on the country in which the study was carried out, with limited longitudinal studies identified to establish any causal relationship. None of the studies found were from the UK. The cross-sectional study found that SVI consistently had a mean of around 0.35, across all waves, which was similar to values reported in Europe and North America. Social vulnerability and frailty were also found to be moderately correlated, again with similar values to those reported previously. Higher mean scores of SV were observed among female (0.34) than male (0.29). Social vulnerability increased with age except a slight decline in ages 60–69 years.
The longitudinal study found that among non-frail participants who were not socially vulnerable at baseline, frailty was rare at follow-up. At higher levels of social vulnerability, significant associations were found. The odds of moderately socially vulnerable people becoming frail had consistent odds of 1.91–2.21, with the highest odds observed for people who were socially vulnerable, with odds from 4.06–6.08 for the last two follow-up periods.
Conclusions: This study was the first to examine SV in England. The key finding was that, in the absence of frailty at baseline, individuals who were socially vulnerable were more likely to become frail than those who were not vulnerable. It would be worthwhile developing a screening programme using an SVI in primary care to identify SV. This could be followed by evidence-based interventions, such as social prescribing and care navigation, in order to reduce social vulnerability and prevent future frailty in community-dwelling older people in England. The use of an SVI for health assessment could be incorporated into the community-based nursing, the NHS long-term plan and person-centred policy in the NHS for early detection of socially vulnerable individuals who could progress to develop frailty in later years. Further research is needed to develop and validate an SVI for use in primary care.