Harttgen K, Kowal P, Strulik H, Chatterji S, Vollmer S

PLoS One 2013;8:e75847

Publication date: October 29, 2013


Frailty is increasingly common as a result of population aging. Assessing levels of frailty in higher versus lower income countries gives a unique perspective on health status at different stages of demographic transitions, and the effect of different policies on functioning and, in turn, on well-being over the life course.

This article provides evidence on frailty in older adults across 14 higher income countries and 6 lower income countries, using a common set of variables to define frailty. The data for these analyses come from two multi-country surveys: SHARE, which is supported by the European Commission, and SAGE, which is supported by the US National Institute on Aging. The second wave of SHARE was conducted in 2006–07 and included 14 countries. SHARE is representing about 12% of the world’s population aged 50-plus in 2011.

Thirty-nine variables from SHARE and 40 variables from the SAGE dataset were used to generate a frailty index. These variables included difficulties in functioning, limitations in activities of daily living, and diseases. To make the results comparable across countries with different population structures, the frailty index is weighted using the standard population distribution based on the WHO World Standard.

Amongst the SHARE countries, the highest mean frailty index scores were seen in Italy, Spain and Poland, the lowest in Denmark, Switzerland and Ireland. In SAGE, the highest frailty score was seen in the Russian Federation. The lower income countries had lower frailty levels than those seen in higher income countries, with China having the lowest mean frailty scores amongst all countries.

The observation that higher frailty scores were seen in the SHARE countries as compared to the SAGE countries could possibly indicate a survivor bias, where social support and health systems allow people in wealthier countries to live longer despite higher levels of frailty.


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