Residential Area Socioeconomic Deprivation is Associated with Physical Dependency and Polypharmacy in Community-Dwelling Older Adults: An Analysis of Health Administrative Data in Ireland

Abstract

Introduction

Socioeconomic disadvantage is associated with multiple adverse health outcomes in ageing. Whether this negative impact persists in populations of more advanced age and dependency is less clear. We aimed to determine the association between residential area deprivation and pre-specified health characteristics among community-dwelling dependent older adults.

Methods

We conducted a cross-sectional analysis of data from 1591 community-dwelling adults aged 65 years and older of mean age 83.9 ± 7.1 years and in receipt of state home support in Ireland. The HP Pobal Deprivation Index was used to categorize residential areas by socioeconomic deprivation. Health variables analysed included physical dependency (Barthel Index), polypharmacy (≥5 medications), previous acute hospital admission, cognitive impairment, and mental health diagnoses. Associations between residential area deprivation and prespecified health outcomes were explored in multivariable logistic regression analysis.

Results

In socioeconomically disadvantaged areas, high physical dependency was twice that observed in affluent areas (16.2% vs 6.9%, p = 0.009). Similarly, acute hospitalization, as the trigger for increased dependency, was more common in deprived settings (41.6% v 29.1%, p < 0.001). Polypharmacy was common in this population (67.6%), but significantly higher in deprived vs affluent settings (74.7% v 64.5%, p = 0.030). The findings persisted in multivariable analyses when adjusted for age and gender. While all participants were accessing home support, those in deprived areas were on average 6.5 years younger than in affluent areas. Associations between residential deprivation and mental health conditions or cognitive impairment, however, were not observed in this study.

Conclusion

Community-dwelling older adults living in socioeconomically disadvantaged areas experienced greater polypharmacy, high physical dependency, hospitalization-associated dependency, and a 6.5-year earlier need for state home support than in affluent settings. The findings suggest that health inequality persists in populations of more advanced age and dependency and highlight a need for further research as well as community-based health and social care initiatives.

Keywords:

• ageing in place
• older adults
• deprivation index
• socioeconomic disadvantage
• health inequalities

Data Sharing Statement

The data that support the findings of this study are available from Health Service Executive (HSE) but restrictions apply to the availability of these data. Data may be available from the corresponding author upon reasonable request with the permission of HSE.

Ethical Approval and Consent to Participate

This study was approved by the Health Policy and Management/Centre for Global Health Research Ethics Committee, Trinity College Dublin (Application: 02/2019/01).

Disclosure

The authors declare that they have no competing interests.

Additional information

Funding

This research was part-funded by North Dublin Home Care, a non-profit organization in Ireland (Registered Charity Number: 20076245). The organization provides a PhD funding bursary for author LS only and does not have a role in the study design, collection, analysis or interpretation of results or paper.