Frailty before and during austerity: A time series analysis of the English Longitudinal Study of Ageing 2002–2018

Background: Frailty is characterised by a reduced resilience to adversity. In this analysis we examined changes in frailty in people aged 50+ before and during a period of austere public spending in England. Methods: Data from the English Longitudinal Study of Ageing 2002–2018 were analysed. Associations between austerity and frailty were examined using (1) Multilevel interrupted times series analysis (ITSA); and (2) Accelerated longitudinal modelling comparing frailty trajectories in people of the same age in 2002 and 2012. Results: The analysis included 16,410 people (mean age 67 years, 55% women), with mean frailty index score of 0.16. Mean scores in women (0.16) where higher than in men (mean 0.14), and higher in the poorest tertile (mean 0.20) than the richest (mean 0.12). In the ITSA, frailty index scores increased more quickly during austerity than before, with the additional increase in frailty 2012–2018 being similar in magnitude to the difference in mean frailty score between people aged 65–69 and 70–74 years. Steeper increases in frailty after 2012 were experienced across the wealth–spectrum and in both sexes but were greater in the very oldest (80+). In the accelerated longitudinal analysis, frailty was lower in 2012 than 2002, but increased more rapidly in the 2012 cohort compared to the 2002 cohort; markedly so in people aged 80+. Conclusion: The period of austerity politics was associated with steeper increases in frailty with age compared to the pre–austerity period, consistent with previously observed increases in mortality.