Frail older adults are heavy users of health and social care. In order to reduce the costs associated with frailty in older age groups, safe and cost-effective strategies are required that will reduce the incidence and severity of frailty. We investigated whether self-reported intensity of physical activity (sedentary, mild, moderate or vigorous) performed at least once a week can significantly reduce trajectories of frailty in older adults who are classified as non-frail at baseline (Rockwood’s Frailty Index [FI] ≤ 0.25). Multi-level growth curve modelling was used to assess trajectories of frailty in 8649 non-frail adults aged 50 and over and according to baseline self-reported intensity of physical activity. Frailty was measured in five-year age cohorts based on age at baseline (50–54; 55–59; 60–64; 65–69; 70–74; 75–79; 80+) on up to 6 occasions, providing an average of 10 years of follow-up. All models were adjusted for baseline sex, education, wealth, cohabitation, smoking, and alcohol consumption. Compared with the sedentary reference group, mild physical activity was insufficient to significantly slow the progression of frailty, moderate physical activity reduced the progression of frailty in some age groups (particularly ages 65 and above) and vigorous activity significantly reduced the trajectory of frailty progression in all older adults. Healthy non-frail older adults require higher intensities of physical activity for continued improvement in frailty trajectories.

Background The level of frailty in the older population across age cohorts and how this changes is a factor in determining future care costs and may also influence the extent of socioeconomic and gender inequalities in frailty. Methods We model cohort-specific trajectories in frailty among the community dwelling population older than 50 years, using five waves (2002–2010) of the English Longitudinal Study of Ageing. We stratify our analysis by wealth and gender and use a frailty index, based on accumulation of ‘deficits’. Results For males and females between the ages of 50 and 70 in 2002, frailty trajectories for adjacent age cohorts converge. However, levels of frailty are higher in recent compared with earlier cohorts at the older ages (for cohorts aged over 70 in 2002). These cohort differences are largest in the poorest wealth group, while for the most affluent, frailty trajectories overlap across all adjacent cohorts suggesting no change across cohorts. Conclusions A key driver of the cohort differences in frailty that we observe is likely to be increased survival of frail individuals. Importantly, this paper illustrates that the social conditions experienced across the wealth distribution impacts on the rate of deficit accumulation in older populations. Our results on trajectories of frailty between 2002 and 2010 are pessimistic and, in the context of rising life expectancies, suggest that poorer older people in particular spend additional years of life in a frail state.

Social exclusion in later life is associated with decreased quality of life and poorer health outcomes. Reducing the number of people at risk of exclusion is a key theme in European social policy, but there is limited understanding of the relationship between neighbourhood characteristics, personal attributes and the level and development of social exclusion in later life. In this paper, cross-classified multilevel growth curve models for predicting exclusion are fitted to seven waves of data from the English Longitudinal Study of Ageing, collected between 2002 and 2015, allowing for the investigation of causal mechanisms linking area characteristics and exclusion in later life, including access to services and amenities, participation in civic, cultural and leisure activities and relationships with friends and family. Results show that living in a deprived area is associated with increased levels of exclusion, and this explained the higher levels of exclusion found for urban compared with rural areas. Population turnover among local residents did not impact on exclusion levels, but length of residence and the degree to which a person feels attached to their neighbourhood did, with ageing in place and stronger attachments predicting lower levels of social exclusion. In terms of individual characteristics, men, those in poor health, people with low levels of wealth or education, and those aged 80 or older, were more likely to experience increased levels of exclusion, while retirement and marriage provided a protective effect. The paper contributes new insights into the pathways through which characteristics of both individuals and neighbourhoods predict social exclusion in later life, and concludes by discussing the policy implications raised by the research.

Pain has been suggested to act as a stressor during aging, potentially accelerating declines in health and functioning. Our objective was to examine the longitudinal association between self-reported pain and the development, or worsening, of frailty among older men and women. The study population consisted of 5,316 men and women living in private households in England, mean age 64.5 years, participating in the English Longitudinal Study of Ageing (ELSA). Data from Waves 2 and 6 of ELSA were used in this study with 8 years of follow-up. At Wave 2, participants were asked whether they were “often troubled with pain” and for those who reported yes, further information regarding the intensity of their pain (mild, moderate, or severe) was collected. Socioeconomic status (SES) was assessed using information about the current/most recent occupation and also net wealth. A frailty index (FI) was generated, with the presence of frailty defined as an FI >0.35. Among those without frailty at Wave 2, the association between pain at Wave 2 and frailty at Wave 6 was examined using logistic regression. We investigated whether pain predicted change in FI between Waves 2 and 6 using a negative binomial regression model. For both models adjustments were made for age, gender, lifestyle factors, depressive symptoms, and socioeconomic factors. At Wave 2, 455 (19.7%) men and 856 (28.7%) women reported they often experienced moderate or severe pain. Of the 5,159 participants who were nonfrail at Wave 2, 328 (6.4%) were frail by Wave 6. The mean FI was 0.11 (standard deviation [SD] = 0.1) at Wave 2 and 0.15 (SD = 0.1) at Wave 6. After adjustment for age, gender, body mass index, lifestyle factors, and depressive symptoms, compared to participants reporting no pain at Wave 2 those reporting moderate (odds ratio [OR] = 3.08, 95% confidence interval [CI] = 2.28, 4.16) or severe pain (OR = 3.78, 95% CI = 2.51, 5.71) were significantly more likely to be frail at Wave 6. This association persisted after further adjustment for either occupational class and/or net wealth level. Compared to those without pain, those with mild, moderate, or severe pain were also more likely to develop worsening frailty, as assessed using the FI, and this association persisted after adjustment for SES. There was no evidence that the association between pain and frailty was influenced by gender. Pain is associated with an increased risk and intensity of frailty in older men and women. Socioeconomic factors contribute to the occurrence of frailty; though in our study do not explain the relationship between pain and frailty.

The importance of neighbourhood on individual health is widely documented. Less is known about the relative role of objective and subjective reports of neighbourhood conditions, how their effect on health changes as people age, and whether they moderate each other's impact on health. This study uses the English Longitudinal Study of Ageing (ELSA) to determine whether older adults report worse self-rated health as they age, and whether this differs between objective and subjective measures of neighbourhood. ELSA data contain 53,988 person-years across six waves collected biannually between 2002 and 03 and 2012 and 13. Objective neighbourhood conditions are measured by the 2004 Index of Multiple Deprivation, and subjective neighbourhood conditions are captured by a summative neighbourhood dissatisfaction score. We find both objective and subjective neighbourhood composite scores independently predict poor health. There is no change over time in the probability of reporting poor health by baseline objective or subjective neighbourhood scores, suggesting neighbourhood effects do not compound as older adults age. There is no moderating effect of area dissatisfaction on the relationship between neighbourhood deprivation and health. The findings provide little support for causal neighbourhood effects operating in later life and indicate different causal pathways through which objective and subjective neighbourhood deprivation impact on health.

Background: the term frailty refers to a condition of increased vulnerability to stressors among older people, leading to a decline in homeostatic reserve. Frailty often leads to falls, hospitalisation and mortality, hence its importance for the delivery of health care to older adults. The pathophysiological mechanisms behind frailty are not well understood, but the decreased steroid-hormone production and elevated chronic systemic inflammation of older people appear to be major contributors. Method: we used a sample of 3,160 individuals aged 50 or older from the English Longitudinal Study of Ageing and assessed their frailty status according to a Frailty Index. We selected 620 single nucleotide polymorphisms in genes involved in the steroid hormone or inflammatory pathways. We performed linear association analysis. The outcome variable was the square root transformation of the Frailty Index, with age and sex entered as covariates. Results: the strongest signal was detected in the pro-inflammatory Interleukin-18 gene (rs360722, P = 0.0021, β = −0.015). Further significant signals were observed in the Interleukin-12 (rs4679868, P = 0.0062, β = −0.008 and rs9852519, P = 0.0077, β = −0.008), low density lipoprotein receptor-related protein 1 (rs1799986, P = 0.0065, β = 0.011) and Selectin-P (rs6131, P = 0.0097, β = −0.01) genes. None of these associations remain significant after Bonferroni correction. Conclusions: we show potential associations between genetic variants of four genes and the frailty index. These genes are involved in the cholesterol transport and inflammatory pathway and, as such, our results provide further support for the involvement of the immunological processes in frailty of the elderly.