title: Explaining the association between educational level and frailty in older adults: results from a 13-year longitudinal study in the Netherlands.
abstract: OBJECTIVE
  The aim of this study was to examine the longitudinal association between educational level and frailty prevalence in older adults and to investigate the role of material, biomedical, behavioral, social, and mental factors in explaining this association.
  
  
  METHODS
  Data over a period of 13 years were used from the Longitudinal Aging Study Amsterdam. The study sample consisted of older adults aged 65 years and above at baseline (n = 1205). Frailty was assessed using Fried's frailty criteria. A relative index of inequality was calculated for the level of education. Longitudinal logistic regression analyses based on multilevel modeling were performed.
  
  
  RESULTS
  Older adults with a low educational level had higher odds of being frail compared with those with a high educational level (relative index of inequality odds ratio, 2.94; 95% confidence interval, 1.84-4.71). These differences persisted during 13 years of follow-up. Adjustment for all explanatory factors reduced the effect of educational level on frailty by 76%. Income, self-efficacy, cognitive impairment, obesity, and number of chronic diseases had the largest individual contribution in reducing the effect. Social factors had no substantial contribution.
  
  
  CONCLUSIONS
  Our findings highlight the need for a multidimensional approach in developing interventions aimed at reducing frailty, especially in lower educated groups.
authors.affiliation: Department of General Practice & Elderly Care Medicine, EMGO(+) Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: e.hoogendijk@vumc.nl.
authors.forename: Emiel O
authors.initials: EO
authors.lastname: Hoogendijk
authors.affiliation: Department of General Practice & Elderly Care Medicine, EMGO(+) Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Hein P J
authors.initials: HP
authors.lastname: van Hout
authors.affiliation: Department of Epidemiology & Biostatistics, EMGO(+) Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Martijn W
authors.initials: MW
authors.lastname: Heymans
authors.affiliation: Department of General Practice & Elderly Care Medicine, EMGO(+) Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Henriëtte E
authors.initials: HE
authors.lastname: van der Horst
authors.affiliation: Department of General Practice & Elderly Care Medicine, EMGO(+) Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Dinnus H M
authors.initials: DH
authors.lastname: Frijters
authors.affiliation: Department of Sociology, VU University, Amsterdam, The Netherlands.
authors.forename: Marjolein I
authors.initials: MI
authors.lastname: Broese van Groenou
authors.affiliation: Department of Epidemiology & Biostatistics, EMGO(+) Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Dorly J H
authors.initials: DJ
authors.lastname: Deeg
authors.affiliation: Department of Epidemiology & Biostatistics, EMGO(+) Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Sociology, VU University, Amsterdam, The Netherlands.
authors.forename: Martijn
authors.initials: M
authors.lastname: Huisman
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000375:Aging / Q000523:psychology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly / Q000523:psychology / Q000706:statistics & numerical data*; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance; D015995:Prevalence; D012111:Residence Characteristics; D012307:Risk Factors; D020377:Self Efficacy; D012923:Social Class
keywords: Education; Frail older adults; Longitudinal study; Socioeconomic position