Background: Monitoring trajectories of intrinsic capacity (IC) in older adults has been suggested by the World Health Organization as a means to inform prevention to avoid or delay negative health outcomes. Due to a lack of longitudinal studies, it is currently unclear how IC changes over time and whether repeatedly measured IC predicts negative health outcomes. Methods: Based on 4 751 repeated observations of IC (range = 0–100) during 21 years of follow-up among 754 older adults 70 and older, we assessed longitudinal trajectories of IC, and whether time-varying IC predicted the risk of chronic activities of daily living disability, long-term nursing home stay, and mortality using joint models. Results: Average IC declined progressively from 77 to 11 points during follow-up, with substantial heterogeneity between older adults. Adjusted for sociodemographics and chronic diseases, a 1-point lower IC value was associated with a 7% increase in the risk of activities of daily living disability, a 6% increase in the risk of a nursing home stay, and a 5% increase in mortality. Accuracy for 5- and 10-year predictions based on up to 3 repeated measurements of IC ranged between moderate and good (area under the receiver operating characteristic curve = 0.76–0.82). Conclusions: Our study indicates that IC declines progressively and that it predicts negative health outcomes among older adults. Therefore, regular monitoring of IC could work as an early warning system informing preventive efforts.

Background: To halt the spread of COVID-19, Austria implemented a 7-week ‘lockdown’ in March/April 2020. We assess whether the ensuing reduction in social contacts led to increased loneliness among older adults (60+).Methods: Three analyses were conducted: (i) a comparison between pre-pandemic (SHARE: 2013–17) and pandemic (May 2020) levels of loneliness (UCLA-3 scale), (ii) an assessment of the cross-sectional correlation between being affected by COVID-19 restriction measures and loneliness (May 2020) and (iii) a longitudinal analysis of weekly changes (March–June 2020) in loneliness (Corona panel).Results: We found (i) increased loneliness in 2020 compared with previous years, (ii) a moderate positive association between the number of restriction measures older adults were affected from and their loneliness and (iii) that loneliness was higher during ‘lockdown’ compared to the subsequent re-opening phase, particularly among those who live alone.Conclusions: We found evidence that COVID-19 restriction measures in Austria have indeed resulted in increased levels of loneliness among older adults. However, these effects seem to be short-lived, and thus no strong negative consequences for older adults’ mental health are expected. Nonetheless, the effects on loneliness, and subsequent mental health issues, could be both more long-lasting and severe if future restriction measures are enacted repeatedly and/or over longer time periods.

Background Whether or not, and how, health inequalities change throughout older age is currently under debate. The goal of this study was to assess the net impact of education, occupational class, income and wealth on frailty trajectories among older adults in Continental Europe. Methods We modelled frailty index trajectories within a repeated cohort design among the community-dwelling population (50+) in 10 countries, using growth curve models based on 54 036 observations from 20 965 respondents in 4 waves (2004–2013) of the Survey of Health, Ageing and Retirement in Europe. Results Gaps in frailty due to education, occupational class and wealth continued throughout old age, while the gap due to income, smaller in comparison, converged. Frailty levels were higher and trajectories steeper in later birth cohorts, and the impact of education increased over time. Frailty levels and growth curves were higher in Southern European countries, and results were consistent across countries regarding the continuous effect of education and occupation and more mixed regarding wealth and income. Conclusions Health inequalities due to education, occupational class and wealth tend to persist throughout old age, whereas the negligible effect of income declines with age, which, substantially, highlights the importance of social conditions on the pace of physiological decline in older Europeans and, methodologically, highlights the need to assess multiple measures of socioeconomic position.

Frailty fluctuations, that is, within-person up and down deviations from individual long-term frailty index trajectories represent a hitherto both conceptually and empirically untapped facet of frailty among older adults. to assess the size of frailty fluctuations in old age and their association with frailty levels, frailty growth as well as sex and socio-economic position. a total of 18,704 biannual observations from 4,514 community-dwelling older adults (65+) in 10 European countries over 12 years from the Survey of Health, Ageing and Retirement in Europe (SHARE) were analysed. A frailty index was constructed based on 50 items. Long-term frailty trajectories and fluctuations were modelled simultaneously using Bayesian mixed-effects location-scale regression models. frailty index fluctuations were non-negligible among older adults, amounting to 0.04/0.05 FI or 2.0/2.5 health deficits on average. 30% of fluctuations were between 0.04 and 0.1 FI (2 and 5 health deficits) and 8% were larger than 0.1 FI (5 health deficits). Fluctuations increased with age and frailty levels, and were higher among women, those with low socio-economic position (education) and individuals who died during follow-up. frailty index fluctuations refer to instabilities in an older person's health status and represent a hitherto untapped but relevant aspect of vulnerability in old age. Future analysis of frailty fluctuations should be based on a larger number of repeated observations with shorter time intervals.

Baseline frailty index (FI) values have been shown to predict mortality among older adults, but little is known about the effects of changes in FI on mortality. In a coordinated approach, we analyzed data from 4 population-based cohorts: the Health and Retirement Study (HRS), the Survey of Health, Ageing and Retirement in Europe (SHARE), the English Longitudinal Survey of Ageing (ELSA), and the Longitudinal Aging Study Amsterdam (LASA), comprising a total of 24 961 respondents (65+), 95 897 observations, up to 9 repeated FI assessments, and up to 23 years of mortality follow-up. The effect of time-varying FI on mortality was modeled with joint regression models for longitudinal and time-to-event data. Differences (of 0.01) in current FI levels (hazard ratio [HR] = 1.04, 95% credible interval [CI] = 1.03–1.05) and baseline FI levels (HR = 1.03, 95% CI = 1.03–1.05) were consistently associated with mortality across studies. Importantly, individuals with steeper FI growth also had a higher mortality risk: An increase in annual FI growth by 0.01 was associated with an increased mortality risk of HR = 1.56 (95% CI = 1.49–1.63) in HRS, HR = 1.24 (95% CI = 1.13–1.35) in SHARE, HR = 1.40 (95% CI = 1.25–1.52) in ELSA, and HR = 1.71 (95% CI = 1.46–2.01) in LASA. FI changes predicted mortality independently of baseline FI differences. Repeated assessment of frailty and individual’s frailty trajectory could provide a means to anticipate further health deterioration and mortality and could thus support clinical decision making.

Previous research found poverty to be associated with adverse health outcomes among older adults but the factors that translate low economic resources into poor physical health are not well understood. The goal of this analysis was to assess the impact of material, psychosocial, and behavioural factors as well as education in explaining the poverty-health link. In total, 28 360 observations from 11 390 community-dwelling respondents (65+) in the Survey of Health, Ageing and Retirement in Europe (2004–13, 10 countries) were analysed. Multilevel growth curve models were used to assess the impact of combined income and asset poverty risk on old-age frailty (frailty index) and associated pathway variables. In total, 61.8% of the variation of poverty risk on frailty level was explained by direct and indirect effects. Results stress the role of material and particularly psychosocial factors such as perceived control and social isolation, whereas the role of health behaviour was negligible. We suggest to strengthen social policy and public health efforts in order to fight poverty and its deleterious health effects from early age on as well as to broaden the scope of interventions with regard to psychosocial factors.