ArticleJournal of the American Geriatrics Society2025
Incidence of Frailty, Dementia, and Disability Among Community-Living Older Americans According to County-Level Disadvantage.
Article in Journal of the American Geriatrics Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
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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.
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Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Toward inclusive healthy ageing: a systematic review of equity in healthy ageing interventions.International journal for equity in health · 2026Pooled it
- Interest in and Feasibility of a Dementia Prevention Program Among Community-Dwelling Older Adults: A Questionnaire Survey.Geriatrics & gerontology international · 2026Article
- Housing Insecurity, Incident Geriatric Conditions, and Mortality in Community-Living Older Persons.JAMA network open · 2026Article
- Association of cumulative deficit frailty with brain age and Alzheimer's disease-related brain structure starting in late-middle age.The journals of gerontology. Series A, Biological sciences and medical sciences · 2026Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundCounty-level contextual disadvantage is a novel social determinant of health (SDOH) for older persons. No prior study has evaluated the national incidence of geriatric conditions according to county-level contextual disadvantage among older persons. Our objective was to estimate the incidence of frailty, probable dementia, and disability over a 5-year period on the basis of county-level contextual disadvantage among community-living older Americans.
methodsThis prospective, nationally representative longitudinal study used data from the 2015 cohort of the National Health and Aging Trends Study (NHATS), linked to various publicly available, geographically based contextual datasets. County-level disadvantage was assessed using the Geriatric Index of County-Level Multi-Dimensional Contextual Disadvantage (GERi-County), which included nine contextual indicators from these linked datasets. Data on frailty, probable dementia, and activities of daily living (ADL) disability were obtained from the NHATS annual assessments (2015-2020).
resultsTotally 7499 participants were included in the analysis, representing 40,728,543 community-living older Americans. The 5-year incidence rates per 1000 person-years were significantly higher in the disadvantaged compared to the non-disadvantaged counties: 52.8 (95% confidence interval (CI), 41.6-64.0) versus 40.3 (95% CI, 37.2-43.3) for frailty; 29.9 (95% CI, 25.4-34.3) versus 21.2 (95% CI, 19.0-23.4) for probable dementia; and 78.1 (95% CI, 70.2-86.0) versus 62.5 (95% CI, 58.2-66.8) for ADL disability. For participants who lived versus did not live in disadvantaged counties, the age- and sex-adjusted HRs were 1.38 (95% CI, 1.08-1.75) for frailty, 1.53 (95% CI, 1.25-1.86) for probable dementia, and 1.30 (95% CI, 1.13-1.49) for ADL disability.
conclusionsCommunity-living older Americans who reside in disadvantaged counties have a higher incidence of frailty, probable dementia, and ADL disability over a 5-year follow-up period compared to their non-disadvantaged counterparts. Findings underscore the vital, underappreciated role that county-level social contextual disadvantage plays on clinically meaningful outcomes in older persons in the U.S.
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