Page 25 - IJPS-11-1

International Journal of
Population Studies A review on early-life determinants of frailty

mediators, including educational attainment, attained adults in the UK Biobank study, Maharani et al. found
social class, and health behaviors in adulthood. A further that being born in the UK, not breastfeeding, maternal
mediation analysis found that the association between smoking, and birth weight outside of a normal range was
intelligence and frailty was mediated through educational associated with lower educational attainment, which, in
achievement, highlighting the benefits of lifelong learning turn, led to a higher level of frailty (Maharani et al., 2023).
and cognitive engagement for maintaining physical health Several studies explored the mechanisms underlying
in later life. the connection between low educational attainment and

3.2. Social factors high risk of frailty and have identified mediators from
different dimensions. Maharani et al. (2023) examined the
Educational attainment and socioeconomic conditions in role of material, biomedical, behavioral, social, and mental
childhood have been well-documented as key contributors factors in the relationship between education and frailty.
to frailty in old age. Research conducted in developed and Income, self-efficacy, obesity, cognitive function, and
developing countries and areas consistently suggests that chronic conditions were the most important mediators.
individuals with lower educational attainment and those Using data from 14,082 community-dwelling persons
who grew up in disadvantaged socioeconomic conditions from 11 European countries, Etman et al. (2015) found
are more susceptible to frailty. that alcohol consumption, social participation, depression,

3.2.1. Education and chronic conditions collectively accounted for the
different frailty levels caused by educational inequalities.
Studies have consistently shown a negative association These findings underscore the multifaceted impact of
between education attainment and frailty, suggesting that educational attainment on the development of frailty,
lack of education could amplify the risk of developing frailty revealing a complex interplay of lifestyle, psychosocial, and
over life. Alvarado et al. (2008) examined the association health-related factors.
between education and frailty using data from a cross-
national survey of older adults living in five large Latin 3.2.2. Parental education
American cities (Bridgetown, Barbados; Sao Paulo, Brazil; The importance of maternal and paternal education
Santiago, Chile; Havana, Cuba; and Mexico City, Mexico). for childhood growth has been well established. Few
Individuals with no schooling (i.e., people who have never studies have considered the role of maternal and paternal
received any forms of formal education, participants who education in developing frailty in old age. Using data from
cannot read or write) had an increased odds of frailty later 6806 individuals aged 60 years or older collected from the
in life than those with more than 12 years of schooling, China Health and Retirement Longitudinal Study, Li et al.
with odds ratios (ORs) ranging from 1.39 to 3.03. Studies (2020) found that individuals whose paternal education
focusing on European populations showed similar findings. was literate were 26% less likely to be frail than those
Soler-Vila et al. (2016) analyzed data from a cohort of whose fathers were illiterate. A subsequent study of the
1857 community-dwelling individuals aged 60 and above. same data set, assessing frailty using the Frailty Index,
They discovered that older women with primary or lower reported similar findings (Yan et al., 2022). Interestingly,
education had about 3 times the likelihood of being frail maternal education was not related to frailty among
compared to those with a university education. Similarly, older Chinese adults. Caution should be exercised when
Herr et al. (2015) found that having ten or fewer years of interpreting these findings as the study observed that over
schooling was associated with 45% higher odds of being 95% of participants’ mothers had no formal education;
frail in a cohort of 2350 French adults aged 70 years or hence, maternal education might not adequately reflect
above. Bai et al. (2023) observed comparable results this cohort’s socioeconomic conditions during the early
regarding the association between lower education levels stages of life.
and an increased risk of frailty, after analyzing data from
the UK and Sweden. More recently, Li et al. (2020) found 3.2.3. Socioeconomic conditions
a nearly dose-response correlation between education Socioeconomic disadvantage in childhood has been
and frailty: older Chinese adults with a primary school, consistently linked to an increased risk of frailty in
middle school, and high school or higher education had a adulthood. Researchers have used several parameters to
36%, 59%, and 77% reduced probability of becoming frail, assess socioeconomic conditions of the children, such as
respectively, than the illiterate ones. the father’s social class, occupation class, and household
In addition to directly affecting frailty, education is a income, and examined its role in shaping the development
mediator between factors in earlier life stages and frailty. of frailty in old age. Gale et al. (2016) found that a lower
Using data from over half a million middle-aged and older father’s social class was associated with a higher risk of

Volume 11 Issue 1 (2025) 19 https://doi.org/10.36922/ijps.1982