Is life-course neighbourhood deprivation associated with frailty and frailty progression from age 70 to 82 in the Lothian Birth Cohort 1936?

ABSTRACT Background Neighbourhood features have been postulated as key predictors of frailty. However, evidence is mainly limited to cross-sectional studies without indication of long-term impact and developmental timing of the exposures. This study explored how neighbourhood social deprivation (NSD) across the life course is associated with frailty and frailty progression among older Scottish adults. Methods Participants (n=323) were from the Lothian Birth Cohort 1936 with historical measures of NSD in childhood (1936-1955), early adulthood (1956-1975) and mid-to-late adulthood (1976-2014). Frailty was measured five times between the ages of 70 and 82 years using the Frailty Index. Confounder-adjusted life-course models were assessed using a structured modelling approach with least angle regression; associations were estimated for frailty at baseline using linear regression, and for frailty progression using linear mixed-effects models. Results Accumulation was the most appropriate life-course model for males; greater accumulated NSD was associated with higher frailty at age 70 (b=0.017; 95%CI: 0.005, 0.029; P =0.007) with dominant exposure times in childhood and mid-to-late adulthood. Among females, mid-to-late adulthood sensitive period was the best-fit life-course model and higher NSD in this period was associated with widening frailty trajectories between age 70 and 82 (b=0.005; 95%CI: 0.0004, 0.009, P =0.033). Conclusions This is the first investigation of the life-course impact of neighbourhood deprivation on frailty in a cohort of older adults with residential information across their lives. Future research should explore neighbourhood mechanisms linking deprivation to frailty. Policies designed to address neighbourhood deprivation and inequalities across the full life course may support healthy ageing. Key messages Neighbourhood context might be associated with old-age frailty, but existing investigations are mainly based on cross-sectional data with limited understanding of the relative importance of exposure timing during the life course. Using a structured approach, we investigated how neighbourhood social deprivation across the life course is associated with frailty, and frailty progression, in a sample of older Scottish adults. Among males, accumulated neighbourhood social deprivation was moderately associated with frailty at age 70 but not with subsequent frailty trajectories; widening frailty trajectories between age 70 and 82 conditional on deprivation during mid-to-late adulthood were identified among females. Gendered experiences of living in deprived areas from childhood onwards may contribute to frailty which should be considered in policies supporting healthy ageing.