Older Adults, Frailty, and the Social and Behavioral Determinants of Health

Objective: To examine the associations between social and behavioral determinants of health (SBDH) and frailty among older adults using an existing Omaha System dataset collected in the community. Design: Secondary exploratory data analysis. Setting: An existing dataset of home health records from a Midwestern region, including Omaha System problems, interventions, and Knowledge (K), Behavior (B), and Status (S) outcomes. Participants: Older adults (n = 1,618) that were 63.7% female with an average age of 80.1 years (SD = 7.6). Methods: This exploratory data analysis study reused an existing Omaha System dataset to reveal hidden patterns in health outcomes of frail vs. non-frail older adults relative to SBDH. Two separate metrics were used to classify SBDH and frailty. An existing summative SBDH index was derived from measures recommended by the Institute of Medicine (IOM). A new frailty index was created based on Omaha System terms mapped to frailty criteria established by Fried and colleagues. Heat maps and line graphs were developed using Microsoft Excel and R. Patterns were discovered and related hypotheses were evaluated using paired samples t-tests and two-way ANOVA tests in R. Results: Records (n = 1,618) were divided into SBDH Group 0 with no SBDH Problems (n = 1,397) and SBDH Group 1 with one or more SBDH Problems (n = 221). Overall, there was significant improvement in KBS after home care interventions. SBDH, Frailty, and interactions between SBDH and Frailty were significantly associated with differences in KBS outcomes. Visualizations showed numerous potential patterns for further research. Discussion: SBDH Group 1 was largely defined by having the Mental health problem. Being in SBDH Group 1 was negatively associated with KBS outcomes. This aligns with the literature on the impact of mental health on overall health and wellbeing. As frailty scores increased, KBS outcomes decreased, demonstrating a possible continuum of increasing frailty as related co-morbidities accrued. This is a new perspective on frailty that should be further investigated. SBDH group, Frailty, and SBDH-Frailty interaction were all important for understanding outcomes for final K, final S, and difference in K, B, and S. For final B, SBDH group and Frailty were important. Because interaction between SBDH and Frailty was observed for most problems and outcomes, researchers who study Frailty should account for SBDH, especially mental health. SBDH problems were infrequent in the data. This has implications for our ability to understand SBDH in home care. Future research should incorporate data that include SBDH problem assessments. Conclusion: This exploratory data analysis study identified relationships between SBDH and frailty for older adults along a continuum of frailty using the Omaha System. Further research is needed to validate the findings and to evaluate the metrics with other datasets and populations.