Differences in the risk of frailty based on care receipt, unmet care needs and socio-economic inequalities: A longitudinal analysis of the English Longitudinal Study of Ageing

Background: The older population is increasingly reliant on social care, especially those who are frail. However, an estimated 1.5 million people over 65 in England have unmet care needs. The relationship between receiving care, or receiving insufficient care, and changes in frailty status remains unclear. Objectives: To investigate the associations between care receipt (paid or unpaid), unmet care needs, frailty status, and mortality. Design: We used multistate models to estimate the risk of increasing or decreasing levels of frailty, using English Longitudinal Study of Ageing (ELSA) data. Covariates included age, gender, wealth, area deprivation, education, and marital status. Care status was assessed through received care and self-reported unmet care needs, while frailty status was determined using a frailty index. Participants: 15,003 individuals aged 50+, using data collected over 18 years (2002–2019). Results: Individuals who receive care are more susceptible to frailty and are less likely to recover from frailty to a less frail state. The hazard ratio of males receiving care transitioning from prefrailty to frailty was 2.1 [95 % CI: 1.7–2.6] and for females 1.8 [1.5–2.0]. Wealth is an equally influential predictor of changes in frailty status: individuals in the lowest wealth quintile who do not receive care are as likely to become frail as those in the highest wealth quintile who do receive care. As individuals receiving care (including unpaid care) are likely to be in poorer health than those who do not receive care, this highlights stark inequalities in the risk of frailty between the richest and poorest individuals. Unmet care needs were associated with transitioning from prefrailty to frailty for males (hazard ratio: 1.7 [1.2–2.4]) but not for females. Conclusions: Individuals starting to receive care (paid or unpaid) and people in the poorest wealth quintile are target groups for interventions aimed at delaying the onset of frailty.