Putting ageism in context: examining the relationship between age discrimination and frailty among older individuals aged 65 years and over.

Aminu, Abodunrin Quadri

Abstract

Frailty is the inability of the body's defence system to cope with stressors. It is known to increase the risk of adverse health outcomes such as mortality, falls and hospitalisation among the older population. While the burden of frailty is continuously documented in the literature, there is still an evidence-practice gap in preventing frailty among the ageing population. To develop strategies that may help prevent frailty, there is a need to recognise its modifiable risk factors. In this study, age-based discrimination has been examined as a potential risk factor for frailty. Additionally, this study aimed to examine social relationships among older adults in terms of social isolation and loneliness and how these might influence the association between reported age discrimination and frailty. This quantitative study involved the secondary data analysis of Waves 5 to 9 of the English Longitudinal Study of Ageing (ELSA). ELSA is a national survey exploring the determinants of health among men and women aged 50 years and over. The data collected in the ELSA data started in 2002 and has continued with two years intervals. The main outcomes selected in this study were frailty (Frailty Index score ≥ 0.25), self-reported health status (0 = good and 1 = poor), social isolation (values ≥ 2) and loneliness (values ≥ 5). Reported age discrimination (Yes or No) was the main independent variable and all the outcomes were dichotomised for the statistical analysis. The outcomes were examined as future outcome (Waves 6 to 9) using the baseline (Wave 5) variables as the predictor and covariates. Future frailty outcome was examined additionally as incident-frailty among individuals who were not frail at baseline but developed frailty in the follow-up period. The binomial generalised estimating equation (GEE) was used for the longitudinal analysis. Mediation analysis was conducted using GEE and bootstrapping approaches to explain the potential relationship between reported age discrimination and frailty. Age, gender, long-standing illness, cognition, socioeconomic status (SES) were all included in the analyses to adjust for confounding effects. The results were reported in odds ratio (OR) at 95% confidence interval (CI) and P-value < 0.05. This study analysed responses from a total of 2,385 individuals aged 65 years and over who participated from Waves 5 through to 9 of ELSA. Among the study population, 55% (n=1,312) were female and 38.5% of the respondents reported age discrimination. The prevalence of frailty was 12% using the baseline data (Wave 5) but 17% from the pooled average over the eight years analysed. A subset of the study population (n=2,097) was not frail at baseline; that is, individuals with FI < 0.25 in Wave 5. Findings from the GEE models after fully adjusting for all the covariates show that reported age discrimination was significantly associated with future frailty/frailty progression (OR 1.49, CI [1.33-1.67]) and incident frailty/frailty development (OR 1.38, CI [1.19-1.60]), future self-reported health (OR 1.19, CI [1.08-1.31]), and future loneliness (OR 1.69, CI [1.53-1.84]). Gender was significantly associated with frailty and women had an increased risk of frailty (OR 1.73) compared to men at P=0.001. The findings from the mediation analysis show that there was a significant indirect effect of reported age discrimination on frailty outcomes. Loneliness accounted for 36% of the association between reported age discrimination and frailty among the respondents in the ELSA data. Findings from this study show that reported age discrimination is associated with frailty progression and frailty development among older adults. The findings demonstrate that women are at higher risk of frailty compared to men and thus, frailty intervention should consider this gender disparity in designing and planning frailty prevention strategies. Additionally, the findings also show that future studies would be needed to examine the relationship between reported age discrimination and mental health. Social interventions such as the introduction of legal frameworks and legislation, awareness to combat ageing stereotypes and a review of age-biased protocols in healthcare can help to reduce age discrimination against older adults and to foster healthy ageing among older individuals.

Citation

AMINU, A.Q. 2022. Putting ageism in context: examining the relationship between age discrimination and frailty among older individuals aged 65 years and over. Robert Gordon University, PhD thesis. Hosted on OpenAIR [online]. Available from: https://doi.org/10.48526/rgu-wt-1712721

• Thesis Type: Thesis
• Deposit Date: Jul 13, 2022
• Publicly Available Date: Jul 13, 2022
• DOI: https://doi.org/10.48526/rgu-wt-1712721
• Keywords: Ageing; Age-based discrimination; Ageism; Frailty; Older adults
• Public URL: https://rgu-repository.worktribe.com/output/1712721
• Award Date: May 31, 2022