Frailty, financial resources and subjective well-being in later life
Introduction
Frailty is an important concept in geriatric medicine. It is closely linked to advanced age and disease-related processes yet is a distinct construct (McMillan & Hubbard, 2012). Frailty is increasingly used as a marker of vulnerability, identifying individuals with a diminished capacity to effectively compensate for external stressors. In community-dwelling populations, those who are frail are at increased risk of death, institutionalization, and worsening disability (Fried et al., 2001, Rockwood et al., 2011, Romero-Ortuno and Kenny, 2012).
While the definition and consequences of frailty are well established, there remain very different approaches to its measurement. One approach identifies frailty as a clinical syndrome or phenotype (a set of signs and symptoms that co-occur to characterize a specific medical condition). The Fried phenotype, for example, identifies frailty as the presence of ≥3 of 5 criteria: weight loss, exhaustion, weak grip strength, slow walking speed, low physical activity (Fried et al., 2001). An alternative to phenotypic approaches is to measure frailty based on the clinician's subjective opinion (Studenski et al., 2004). In a third approach, frailty is conceptualized as a multidimensional risk state measured by the quantity rather than the nature of health problems (Mitnitski, Mogilner, & Rockwood, 2001). In this paradigm, individuals accumulate deficits throughout their lives: the more deficits an individual has, the higher the likelihood they will be frail (Rockwood & Mitnitski, 2007). Understanding frailty has become the focus of extensive research. The associations of frailty with increasing age, female gender, functional dependence and chronic disease are now well described (Walston et al., 2006).
Though the relationships among aging, frailty, and psychological well-being have been less comprehensively explored (Fillit & Butler, 2009), a small number of studies have recently linked frailty to poorer quality of life. In 1318 community-dwellers, an index of self-rated health was moderately correlated with frailty (r = 0.49) (Lucicesare, Hubbard, Searle, & Rockwood, 2010) and in 1008 older Hispanic adults being frail was significantly associated with lower scores on all physical and cognitive health related quality of life scales (Masel, Graham, Reistetter, Markides, & Ottenbacher, 2009). Similarly, in a larger cohort of 5703 participants of the Canadian Study of Health and Aging, frailty was significantly associated with poorer psychological well-being scores, independent of age, sex, education, cognition, and mental health (Andrew, Fisk, & Rockwood, 2012). Well-being has also been shown to be cross-sectionally associated with cognitive function in older adults (Llewellyn, Lang, Langa, & Huppert, 2008).
The impact of financial resources on subjective well-being has received more attention, though results are somewhat conflicting. While higher socioeconomic status has pervasive positive effects on both health and mortality (Marmot, 2005), the association between objective measures of wealth and psychological well-being is less clear cut. Some report strong positive associations between wealth and quality of life (Rosero-Bixby & Dow, 2009) and, within countries, those with higher incomes tend to be happier (Graham, 2008). Others argue that the overall contribution of economic status to subjective well-being is trivial (Myers, 2000) and that aspirations increase along with earnings such that “hedonic adaptation” and social comparison annul the positive effects of increased income (Easterlin, 2003). Wealth may become more important when individuals face difficult life circumstances. For example, in the US Health and Retirement Study those above the median in total net worth reported a smaller decline in well being after the onset of a disability than their less well-off peers (Smith, Langa, Kabeto, & Ubel, 2005).
In this study we had two objectives: first, to investigate the association between frailty and subjective well-being in older people; second, to explore the impact of household wealth and income on this relationship.
Section snippets
Sample
We used data from Wave 1 of the English Longitudinal Study of Aging (ELSA, 2002), a nationally representative panel study of 11,392 community-dwelling adults aged 50 and over in England. ELSA participants were recruited from households involved in the Health Survey for England, an annual government-sponsored cross-sectional survey, in 1998, 1999 and 2001. Households were included in ELSA if one or more individuals living there were aged 50 or over. Analyses of socio-demographic characteristics
Results
Study participants included a slight majority of women (52.3%) and the mean age of participants was 71.0 years. Most participants engaged in moderate physical activity at least once per week and 86.9% were non-smokers (Table 1). FI scores increased with chronological age and were significantly higher in those who did not participate in exercise but there was no significant difference in frailty levels between smokers and non-smokers.
There was a marked association between frailty and poor
Discussion
In this large sample of community-dwelling older adults, higher levels of frailty were associated with poorer subjective well-being. The FI correlated well with an established measure of well-being, the CASP-19. Individuals with greater financial resources reported better subjective well-being; this association was primarily observed in relation to income rather than wealth though there is likely to be co-linearity between the two. The poorest participants in each frailty category had similar
Conclusions
This study contributes to our understanding of the relationship between frailty and subjective well-being in older adults. Here, older people with greater financial resources reported better subjective well-being with evidence of a “dose–response” effect. The poorest participants in each frailty category had similar well-being to the wealthiest with worse frailty status. Since the pathways to frailty development are complex and currently poorly understood, understanding the impact of frailty is
Funding
This work was supported by the UK National Institute for Health Research (NIHR) Collaboration for Applied Health Research and Care (CLAHRC) for the South West Peninsula. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
Conflict of interest statement
None.
References (39)
- et al.
Developing attributes for a generic quality of life measure for older people: Preferences or capabilities?
Social Science and Medicine
(2006) Social determinants of health inequalities
Lancet
(2005)- et al.
Psychological well-being in relation to frailty: A frailty identity crisis?
International Psychogeriatrics
(2012) - et al.
Social vulnerability, frailty and mortality in elderly people
PLoS ONE
(2008) - et al.
Frailty and type of death among older adults in China: Prospective cohort study
British Medical Journal
(2009) Explaining happiness
Proceedings of the National Academy of Sciences of the United States of America
(2003)- et al.
The relationship of self-reported distress to depressive disorders and other psychopathology
Journal of Consulting and Clinical Psychology
(1994) - et al.
The frailty identity crisis
Journal of the American Geriatrics Society
(2009) - et al.
Frailty in older adults: Evidence for a phenotype
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
(2001) - et al.
Frailty index as a measure of biological age in a Chinese population
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
(2005)
Happiness and health: Lessons–and questions–for public policy
Health Affairs (Millwood)
Inflammation and frailty measures in older people
Journal of Cellular and Molecular Medicine
A measure of quality of life in early old age: The theory, development and properties of a needs satisfaction model (CASP-19)
Aging and Mental Health
Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: Lessons from the Cardiovascular Health Study
Journal of the American Geriatrics Society
Neighborhood deprivation, individual socioeconomic status, and frailty in older adults
Journal of the American Geriatrics Society
Longevity increased by positive self-perceptions of aging
Journal of Personality and Social Psychology
Cognitive function and psychological well-being: Findings from a population-based cohort
Age and Ageing
An index of self-rated health deficits in relation to frailty and adverse outcomes in older adults
Aging Clinical and Experimental Research
Frailty and health related quality of life in older Mexican Americans
Health and Quality of Life Outcomes
Cited by (45)
Is it all about money honey? Analyzing and mapping financial well-being research and identifying future research agenda
2022, Journal of Business ResearchCitation Excerpt :Financial education impacts financial well-being directly (Annink et al., 2016; Drever et al., 2015) or indirectly (Painter, 2013). While social welfare (Annink et al., 2016), mental wellbeing (Elbogen et al., 2012), medicaid (Hu et al., 2018), financial literacy (Schmeiser & Seligman, 2013), and financial capital (Hubbard et al., 2014) directly affect financial well-being, life events (namely widowhood) impact financial well-being through financial education and financial knowledge (O’bryant & Morgan, 1989). The program for financial education improves financial well-being (Hageman et al., 2019), while financial literacy and financial intelligence, as shown by Limbu and Sato (2019), Mahendru (2020) and Riitsalu and Murakas (2019), affect financial well-being through financial behavior.
Impact of frailty status on health and quality of life in Spanish older adults
2020, Atencion PrimariaNormative Estimates and Agreement Between 2 Measures of Health-Related Quality of Life in Older People With Frailty: Findings From the Community Ageing Research 75+ Cohort
2020, Value in HealthCitation Excerpt :The FI score is calculated as an equally weighted proportion of the number of deficits present in an individual relative to the total possible. The FI groups individuals into 4 categories: very fit (FI score of 0-0.10), well (>0.10-0.14), vulnerable (>0.14-0.24), and frail (>0.24).15 The eFI score is based on the cumulative deficit model of frailty, including 36 variables recorded in the primary care electronic health record as part of routine care.
Trends in Frailty Prevalence Among Older Adults in Korea: A Nationwide Study From 2008 to 2020
2023, Journal of Korean Medical Science