# Comparing the Relationship Between Social Determinants of Health and Frailty Status of Medicare Beneficiaries in Rural and Urban Areas in the United States

## TL;DR

This study explores how social factors and geography affect frailty in older adults, finding that urban and rural areas show different patterns.

## Contribution

The study reveals how social determinants interact with rural and urban residence to influence frailty in older adults.

## Key findings

- Geographic residence was not directly linked to frailty status (p = 0.73).
- Medigap insurance coverage was associated with lower odds of worse frailty status (p = 0.04).
- Marital status showed inconsistent frailty trends in urban areas (p < 0.001).

## Abstract

Frailty is a geriatric syndrome of increased physiological vulnerability, decreasing an older adult’s ability to successfully cope with health stressors. Social determinants of health (SDOH), including rural residence, can amplify healthcare disparities for older adults due to less accessibility to resources and lead to worse health outcomes. While the impact of rurality on older adult health is well-established, little is known about how the interaction of SDOH and geographical residence impact frailty status in older adults.

Older adults (65+ years) in the National Health and Aging Trend Study (2011–2021) were categorized using Fried’s frailty phenotype (robust, pre-frail, frail). Rurality was defined using the 2013 Rural–Urban Continuum Codes. Generalized estimation equations with generalized logit link function determined the relationship between SDOH (healthcare access, community support, income, education) and frailty status.

Of n = 6082 participants (56.4% female), the mean age was 75.12 years (SE 0.10), 1133 (18.6%) lived in rural residence, and 2652 (53.0%) had pre-frailty. Although there was no relationship between geographical residence and frailty status (p = 0.73), we did observe lower associated odds of worse frailty status for those with Medigap insurance coverage (0.81, SE 0.08; p = 0.04) and inconsistent frailty status trends for those of divorced (1.12, SE 0.05; p = 0.007) and never married (0.20, SE 0.03; p < 0.001) status in urban areas.

Our findings suggest that geographic residence may modify the relationship between SDOH and frailty status in older adults, providing novel insight into the complexity of these interactions. This work is important for identifying modifiable areas where additional support interventions may be important for mitigating frailty development and progression for older adults with efforts at both the individual and system levels.