To rapid increase in the numbers of frail

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Last updated: September 21, 2019

To What Extent does Education, Income and Marriage affect Frailty?Abstract There has been a rapid increase in the numbers of frail patients’ due to anaging population, which is having a great impact on health care systems aroundthe world.  Frailty is mainly diagnosedin elderly patients and a range of different factors can influence the age atwhich patients become frail.  Thisinvestigation will focus on the impact of education, income and marriage, butother factors including certain types of behavior may also affect frailty. Thisessay shows how age, gender and time affect these factors. IntroductionThe aim of this essay is to identify if income, education and marriage linkto frailty. Frailty is a clinical syndrome, whose prevalence increases with age(Mello et al.

, 2014). By exploring social factors, we may be able to identifyat risk patients, who would be more likely to become frail. This investigationexplores if social and health inequalities impact the prevalence of frailty.Whilst most social factors do not affect the pathophysiology of frailty, theyoften influence the process of frailty (Mello et al., 2014)MethodIn order to research this topic, journals and articles were found using NHSevidence, TRIP database and Medline. Also, a Boolean Search technique was usedto refine the search results and the following terms were used; “frailty”,”social”, “education” and “marriage”. I filtered the search again by language andfrom the year 2000 and excluded studies that didn’t show frailty as an outcome.

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Education Many studies, such as the Exeter UK study by Lang et al. 2009, assessedfrailty using the frailty index, they show an inverse relationship betweeneducation and frailty. The frailty index is a ratio calculated from the numberof deficits a person shows over the total number of deficits according toSearle et al.’s study.  It ranges from 0to 1 and deficits can include symptoms, diseases and disabilities and the greaterthe value, the more frail the person (Searle et al., 2008).  The study by Lang et al.

2009 compares thefrailty index with the age of completion of full-time education. It shows that44.0% of participants had completed full-time education by age 14 or less andhad a frailty index of 0.17. However, 11.9% of the participants finishedfull-time education at an age of 18 or over and had a mean frailty index of0.11.

This is lower than those, who completed their education by 14. Theassociation that this study shows between frailty and education may beinfluenced by behavioral factors, as less educated people are more likely tohave unhealthy habits such as alcohol consumption, smoking and poor diet(Hoogendijk et al., 2014).

A population-based cohort study in America by Chamberlain et al., 2016explored the social and behavioral factors associated with frailty trajectoriesand found that education had one of the greatest social impacts. The frailtytrajectories were measured by using the first frailty index that was recordedas the baseline frailty index measure. The study showed 60-69-year old’s werefive times more likely to have a higher baseline frailty index if they had lessthan a high school education compared to those who had a four-year college degreeor higher. However, the participants aged 70-79 were only three times aslikely. This may demonstrate that the impact of education on frailty decreaseswith age and the older participants, the less education impacts frailty.Perhaps, this is due to other physical factors having a greater impact on theprevalence of frailty in more elderly participants.

The article suggests thatthere is an indirect relationship between education and frailty and that loweducation can reduce the quality of life, which in turn increases theprevalence of frailty (Mello et al., 2014) A study from Amsterdam by Hoogendijk et al., 2014 illustrates the inverselink between frailty and education, but also identified that the rate at whichthe prevalence of frailty increases, doesn’t vary with educational level.  Low education level was defined as belowelementary school (finished school at less than 12 years of age), medium levelas general intermediate education and high level as college or university.Frailty was measured by using a study by Fried et al 2001, where frailty isjudged by change in weight, grip strength, exhaustion, gait speed, and physicalactivity. The participants are then categorized into robust, pre-frail orfrail.

Over 13 years, the study (Hoogendiijk et al., 2014) had shown nostatistical difference between education level and the rate of new cases offrailty as all three education levels showed similar rate of increase in thepercentage of frail participants. However, it did show that participants were almostthree times more likely to be frail, if they were from a lower educationallevel than a higher level. This shows that the impact of education does notincrease the rate of new frailty cases but increases the prevalence (Hoogendijket al., 2014).  The study also suggeststhat lower education links to greater environmental stress, but fewermechanisms and resources to manage them, which can lead to an increased risk offrailty (Kristenson et al.

, 2004). The study also linked low education toliving in deprived areas, poverty and low income.IncomeAs with education, there is an inverse relationship between income andfrailty (Woo et al.

, 2005). A study by Bandeen-Roche et al., 2015 in Americademonstrates the relationship between income and frailty. The study divided theincomes into quintiles and recorded whether the participants were robust,pre-frail or frail using a study by Freid et al., 2005. In the study, 25.8% ofparticipant’s whose income was in lowest quintile were frail, but only 5.9% ofthe participants whose income was in the higher quintile were frail.

  A lower income can contribute to lower healthcare resources and poor nutrition, which can result in patients being morevulnerable to adverse health outcomes (Bandee-Roche et al., 2015). In addition,lower income can lead to less paid support and assistance, which can lead to aworse quality of life and an increased likelihood of frailty (Bilotta et al.,2010) A similar correlation is shown when looking at the perception of income(Alvarado et al., 2008). A cohort study in five Latin American countries byAlvardo et al., 2008 measured the odds ratio for frailty and whether theparticipants perceived they had a sufficient income.

Frailty was again measureby the five components from the Fried et al., 2001 study. The odds ratio forfrailty and the perception of insufficient income versus a perception of asufficient income in Bridgetown was 1.31, in Havana 1.59, in Mexico DC 1.74, inSantiago 1.

58 and in Sao Paulo 1.47. The odds ratio were all over one, whichshows that participants, who perceived themselves as having an insufficientincome, were more likely to be frail.

The study suggests that the differencebetween the odds ratio in different cities may be due to availability ofservices and health care. It also showed that the highest levels of frailtywere found in the participants with the lowest income, poorest socialconditions and having the most chronic diseases. The study suggests that thosewho had a low perception of their income and excess frailty had reported fewerenjoyable opportunities in their life, which may link to a higher risk ofmental illness. However, this study if from Latin America and may not becomparable to the UK.

A study by Stolz et al. 2005 identifies the link between poverty andfrailty in ten countries across Europe. The study measures wealth of theparticipant, their frailty index and if they are at a poverty risk. Theinvestigation found that participants not at a poverty risk had a mean frailtyindex of 0.

17 and that participants at poverty risk had a mean frailty index of0.23. This shows that there is positive relationship between poverty andfrailty.

The study explains how poverty increases the chances of an unhealthylifestyle such as limited physical activity and obesity, both which increasethe risk of frailty. It also explains why elderly participants in poverty aremore likely to have had a lower education, low-income employment and to live ina deprived area throughout their life course, which all have adverse healtheffects. Also, the study explains how participants in poverty felt less incontrol of their health and had poorer accommodation and resources.  MarriageAccording to various studies, marriage appears to have a positive effect onfrailty.

For example, a study in Italy by Poli et al., 2017 showed that 63.1%of married participants were not frail (robust) but only 36.6% of frailparticipants were married.  Thedifference in percentages may be due to more psychological and socioeconomicsupport and the decreased risk of social isolation and a lower risk ofdepression. However, people who have, overall, better health and socioeconomicresources are more likely to get married according to the marital selectiontheory and are therefore less likely to develop frailty.

(Waldron et al.,1996).  In addition, in the study be Poleet al.

, 24.7% of the robust participants were widows/widowers whilst 48.4% ofthe frail participants were widows/widowers. This could suggest that the frailparticipants were older and therefore more likely to have outlived theirpartner and that age has a greater impact than marriage. Therefore, otherstudies that show the age of the participants must be compared.

  Marriage appears to have less of an effect on frailty the older theparticipants are. An example of this is a study by Chamberlain et al., 2016,which shows a similar relationship to the impact of education on frailty overtime.

The results of the study showed that the baseline frailty of not marriedversus married for participants aged 60-69 was 2.49, for ages 70-79 was 1.61and for 80-89 year old’s was 1.53. This illustrates that marital status hasless of effect on frailty with age. This is confirmed by another study whichfocuses on participants aged 90 or above (Lee et al.

, 2016). The study reportedthat there was no significant impact of marriage on the prevalence of frailtyin the participants. This may be due to age and other factors becoming moreinfluential.

However, the effect of marriage on frailty varies with gender and this isillustrated by a study in Italy (Treisian et al., 2016). The study measuredfrailty using the Fried et al., 2001 study and illustrated that maleparticipants, who have never married are 3.07 times more likely to developfrailty than male participants that had married. However, the femaleparticipants, who had never married are 1.58 times more likely to be frail thanthe women who have been married. The study suggests that this link may be dueto the fact that when the participants were adults in the mid-20thcentury, women were more likely to bring benefits to the marriage, such ashousehold management, food preparation and health care.

It also suggests thatas women having, on average, a longer life expectancy than men, are more likelyto take up caring roles later in life, which can lead to an increased risk ofdepression (Trevisan et al., 2016). ConclusionIn conclusion, this essay aimed to identify if four social factors had animpact on the prevalence of frailty and this essay shows that whilst lowincome, education and loneliness increases the likelihood of patients beingfrail, marriage has a positive impact on the prevalence of frailty. However,the investigation did show that the impact of education and marriage is lesssignificant with age and that the factors influence genders differently.  There are multiple factors that affectfrailty that have not been identified in this essay such as diet, smoking,environment and employment. The findings in this investigation shows theimportance of decreasing health inequalities in order to reduce the number ofpatients being diagnosed with frailty. Also, it may be able to help health care professionals identify patientswho are at a high risk of being frail.


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