Evidence map›Paper›PMID 40056410›Full record

ArticleThe Journal of frailty & aging2025

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.

David R Sinclair, Asri Maharani, Andrew Clegg, Barbara Hanratty, Gindo Tampubolon, Chris Todd, Raphael Wittenberg, Terence W O'Neill, Fiona E Matthews

Abstract read
In one paragraph

Article in The Journal of frailty & aging, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

David R SinclairNational Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK. Electronic address: David.R.Sinclair@Newcastle.ac.uk.
Asri MaharaniDivision of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK.
Andrew CleggAcademic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, School of Medicine, University of Leeds, Leeds, LS2 9JT, UK.
Barbara HanrattyNational Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK.
Gindo TampubolonGlobal Development Institute, School of Environment, Education and Development, Faculty of Humanities, University of Manchester, Manchester, M13 9PL, UK.
Chris ToddNational Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK.
Raphael WittenbergNational Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, Care Policy and Evaluation Centre, The London School of Economics and Political Science, London, WC2A 2AE, UK.
Terence W O'NeillNational Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PL, UK.
Fiona E MatthewsNational Institute for Health and Care Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK; University of Hull, Cottingham Road, Hull, HU6 7RX, UK.

Funding

Project-001R01AG017644 · NIA · UNIVERSITY OF LONDON INST OF NEUROLOGY · PI Andrew Steptoe · 2000 to 2026
$56.2M
NIA NIH HHS R01 AG017644
6 · The paper itself

Abstract

backgroundThe 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.

objectivesTo investigate the associations between care receipt (paid or unpaid), unmet care needs, frailty status, and mortality.

designWe 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.

participants15,003 individuals aged 50+, using data collected over 18 years (2002-2019).

resultsIndividuals 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.

conclusionsIndividuals 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.

Indexed as

Frail ElderlyFrailtyHealthcare DisparitiesHealth Services Needs and DemandAgedAged, 80 and overAgingEnglandFemaleGeriatric AssessmentHumansLongitudinal StudiesMaleMiddle AgedRisk FactorsSocioeconomic FactorsELSAHealthy ageingMultistate modelPrefrailUnmet need for care

Identifiers

PMID40056410
PMCPMC11959111

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.