Ageing in austerity: Study connects public spending cuts to increased frailty

By Dr. Priyom Bose, Ph.D.Feb 14 2024Reviewed by Lily Ramsey, LLM

Frailty entails a reduced resilience to adversity. A recent PLoS ONE study used a period of austerity public spending in England to note the changes in frailty in individuals aged 50 years and above.

Study: Frailty before and during austerity: A time series analysis of the English Longitudinal Study of Ageing 2002–2018. Image Credit: Paul Maguire/Shutterstock.com

Background

Following the global financial crisis in 2008/9, many countries implemented policies of austerity to varying degrees as they aimed to reduce public budget deficits through a combination of lower public spending and higher taxes.

The former was prioritized in the UK, where government spending was cut across social care, local government budgets, and welfare. The spending on NHS also began to fall in the 2010s while the population continued to age. This has been noted in the leveling off and increase in life expectancy rate since 2014.

A multi–system decline over a lifetime leads to frailty, which leads to reduced capacity and lower resilience to recover from shocks. It is associated with adverse events, such as longer hospital stays, higher risk of falls, poor quality of life and death.

Studying changes in frailty in the context of austerity is important as it gives us a sense of the health of older individuals and their likelihood to live independently in the long term.

About this study

Data for this study was obtained from the nationally representative English Longitudinal Study of Ageing, ELSA, (2002 to 2018).

The main objective was to examine whether frailty rose at different rates during periods of austerity than before. Multilevel interrupted times series analysis (ITSA) was used to study the correlation between frailty and austerity.

Additionally, frailty trajectories of similarly aged individuals in 2002 and 2012 were analyzed using accelerated longitudinal modeling.

The main outcome variable of interest was a frailty index score based on Rockwood’s frailty deficit model. In this approach, the score is the proportion of deficits in a given individual, ranging from 0 (no deficits) to 1.

The scores were square–root transformed because the distribution was stronglyright–skewed.

Key findings

A total of 16,410 individuals were included in the analysis, of which 8,977 were women. Across all years, the mean age was 67. The range of the frailty score was between 0 and 0.76 and had a mean and median of 0.15 and 0.12, respectively.

It was documented that frailty increased with age and was higher in women (mean of 0.16), compared to men (mean of 0.14). It was also highest for the poorest individuals.

During periods of austerity (2012-2018), the frailty score rose faster compared to the period before the implementation of austerity (2002-2010). Using a diverse cohort of individuals, this study constructed individual wealth measures and a robust frailty index score before and after austerity.

It was also observed that when public spending on health rose (2000s to 2010s), the mean population frailty fell. However, this gain was largely reversed due to the accumulation of frailty deficits during austerity.

Therefore, the population may be less resilient to more austerity in the 2020s, compared to the 2010s.

A key limitation of this study is that the frailty index score relies on self-reported measures. One cannot rule out changing trends in how an interviewee answers questions in questionnaires.

It could also be the case that the rise in frailty in the 2010s simply reflects the aging of the cohort and is not really driven by austerity.

Third, the ELSA experiences non–random attrition from males, those in poor health conditions, and those from lower socio–economic backgrounds.

This non-random attrition could also have biased the results. A final limitation is common across all observational studies in that this is a study of correlations, and causality cannot be established. 

Conclusions

This study documented that compared to pre-austerity periods, the period of austerity was associated with higher increases in frailty with age. This finding is in line with previously observed increases in mortality.

The results are highly policy-relevant, whereby reduction in public spending adversely affects health and mortality.

Many countries are currently facing budget challenges owing to the pandemic, energy crisis, and inflation. Proposals to cut public spending should be evaluated carefully based on the findings documented here. 

Future research should shed light on the causes of deterioration in health outcomes during periods of austerity compared to before.

Furthermore, the specific deficits encapsulated in frailty should be analyzed to see if the results are driven by individual deficits more susceptible to short-term austerity.