Frailty Trajectories and Social Determinants of Health of Older Adults in Rural and Urban Areas in the U.S.

Abstract

Older adults, aged 65 years and older, develop and experience frailty at different rates. Yet, this heterogeneity is not well understood, nor are the factors, such as geographical residence, that influence different frailty trajectories and subsequent healthcare outcomes. We aim to identify factors that impact older adult frailty trajectories, skilled nursing facility (SNF) placement, and death. Medicare beneficiaries ≥ 65 years from the National Health and Aging Trend Study (2011–2021) with complete data using Fried’s frailty phenotype on ≥ 2 occasions (n = 6082) were included in the analysis. Rural/urban residence was defined using Office of Management and Budget criteria. Latent class growth analysis (LCGA) helped identify four frailty trajectories: improving, stable, mildly worsening, and drastically worsening. Cox proportional hazard analysis and logistic regression determined the association of social determinants of health (sex, race/ethnicity, education and income level, healthcare and transportation access, and social support) on death and SNF admission, respectively. The mean age was 75.12 years (SE 0.10); 56.4% female, 18.6% (n = 1133) rural residence. In the overall sample, 1094 (23.0%) older adults were classified as robust, 3242 (53.0%) as pre-frail, and 1746 (24.0%) as frail. Urban residence did not modify the relationship between frailty trajectories and SNF placement, nor did geographic residence on death. Higher income was associated with lower odds of a worse frailty trajectory, SNF admission, and a lower hazard of death, all reaching statistical significance. Future work should examine the factors that influence older adult participation in research and the impact of standardizing the definition of geographic rurality on older adult frailty and health outcomes.