Social Determinants of Frailty in Elderly Mexican Community‐Dwelling Adults

In geriatrics, frailty is understood as a biological syndrome associated with negative health-related outcomes, such as disability and morbimortality,1 but there are no universally accepted diagnostic criteria for this syndrome, much less studies approaching it from a nonbiological framework. Nonetheless, some previous work has been able to highlight social factors as important features implicated in the development of this entity.2, 3 To identify these factors could be of great importance to establish potential multidimensional models to prevent or treat frailty, but such associations have not been sufficiently studied, including in Latin American populations, which present unique social contexts. The aim of this study was to identify the social factors associated with prevalent frailty in elderly Mexican community-dwelling adults. This was a cross-sectional study of 418 men and 509 women aged 70 and older participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty.4 Possible social correlates tested were educational level (years studied), parents' educational level (years studied), marital status, history of childhood illness, amenities in the home (e.g., type of home, running water, telephone, television, radio, refrigerator), socioeconomic status, home ownership, employment benefits (e.g., pension, healthcare services, life insurance, profit sharing, grocery vouchers), ability to make important decisions, religiosity, volunteering, living offspring, friends or family living in the same neighborhood, financial support, occupational history, and elder abuse. Frailty was defined as proposed by Fried and colleagues.1 Multinomial logistic regression analyses were performed to find the best model, and the variables significantly associated with frailty were retained. Partial F-tests were used to eliminate from the model variables judged to be nonsignificant at the 5% level. Mean age was 78.2 ± 6.2 (range 70.3 to 104.4), and 54.9% of participants were female. Hypertension was the most frequent chronic disease (55.9%), and prevalent disability in activities of daily living (ADLs) was present in 29.1% of participants. Frail, prefrail, and nonfrail prevalence was 14.1% (n = 131), 37.4% (n = 347), and 48.5% (n = 449), respectively. Table 1 shows the multinomial regression analyses of frailty and significant social correlates. In comparison with the nonfrail subgroup, not having a partner (odds ratio (OR) = 1.48), not making important decisions in their lives (OR = 1.82), receiving employment benefits (OR = 0.92), and being subject to abuse (OR = 1.38) were statistically significant correlates of prefrail status. Not having a partner (OR = 1.99), not making important decisions in their lives (OR = 2.94), receiving employment benefits (OR = 0.86), being abused (OR = 1.34), and having poor self-perceived socioeconomic status (OR = 1.69) were associated with frailty. Social factors are important in understanding frailty. Previous research in elderly Latin American adults has found that social factors such as poor socioeconomic conditions, little education, non-white collar occupation, and insufficient income are more frequently present in frail individuals.2 The results of the present study were similar to those previously reported. Not having a partner was a correlate of prevalent frailty, which could be explained by the fact that isolated elderly adults more frequently develop depressive symptoms.5 Alternatively, not making important decisions has not been previously reported as a correlate of prevalent frailty. This variable might be associated with frailty because this population's frequent lower cognitive performance is associated with disability and the inability to make important choices.4, 6 Also, having a poor self-perceived economic situation was more common in frail participants, which could be explained by the fact that, in Latin American countries, low income frequently coexists with inaccessible medical care, malnutrition, and poor education, among other risk factors.2 In addition, individuals receiving employment benefits were protected against frailty, which may be a reflection of these participants having better living conditions. Several geriatric syndromes such as cognitive impairment and disability have been reported to be risk factors for elder abuse;7 this finding might explain their coexistence with frailty in this cohort. It was hypothesized that the combination of these factors might indicate a socially and medically inadequate environment, increasing the odds of being frail. This is the first study to report such associations in Latin America. Social factors often ignored in the medical context might represent risk factors for the development of frailty and therefore should be assessed and taken into account when evaluating an elderly person and when developing multidimensional prevention and treatment programs for this population. More longitudinal studies are needed to better describe this association in different populations around the world. This research was conducted as part of the Mexican Study of Nutritional and Psychosocial Markers of Frailty among Community-Dwelling Elderly. This project was funded by the National Council for Science and Technology of Mexico (SALUD-2006-C01- 45075). Conflict of Interest: None. Author Contributions: Itamar Casale-Martínez: Concept and design of study, analysis and interpretation data, and writing of the manuscript under the supervision of Drs. Navarrete-Reyes and Ávila-Funes. The coauthors certify that they have participated substantially in the conceptualization and design of this work and the analysis of the data as well as the writing of the manuscript. They have reviewed the final version of the manuscript, and have approved it for publication. Sponsor's Role: None.