We describe the use of a Frailty Index based on two surveys (including valid holistic measurements of health-related quality of life (HrQOL) and depression) as well as seven physiologic measurements commonly used in primary care clinics. This Frailty Index is a highly reproducible, multi-dimensional measurement of the well-being of individuals, and conceptualizes the health of a biologic system. 20–25 We report the baseline level of Frailty, as well as gender and Colonia differences. We believe that the Frailty Index characterizes many of the unique contributors to HrQOL and Frailty in the Hispanic population of the Colonias and postulate multifactorial reasons for the results and variations.
A cross-sectional representation of residents of Indian Hills showed little change of Frailty with advancing age, whereas Frailty increased dramatically with age in the more established Cameron Park, with the peak frailty index scores between 40–60 years old. Deficit accumulation—such as poverty, reduced healthcare access, less education, physical decline due to manual labor, reduced social capital, environmental toxins, and genetic changes— affect health and well-being. 26,27–30
Frailty Index calculated against age and Colonia was regressed against age. Indian Hills had a significantly higher starting frailty however, Cameron Park had a significantly greater rate of change with age. Indian Hills is a younger Colonia, more transient, and with fewer established, multi-generational families. Prior researchers note positive contributors to Frailty in Hispanic dense, cultural and language congruent neighborhoods that suggest that social capital, positive cultural protection, reduced social vulnerability, and proximity to language and cultural-based assistance, protect against Frailty.31–33 Perhaps an immigrant paradox protects the health of families in Indian Hills; families that we cared for in Indian Hills may be more willing to seek medical care, be more supportive for the elderly, or are newer immigrants.
We found that women score higher in Frailty than men when young, but the FI for men worsened rapidly with advancing age. Earlier studies attempt to explain gender-based differences found in Frailty. In our sample, women and men have the same prevalence of disease (except triglycerides), yet the frailty indices are higher for women. 30,34,35 Socio-behavioral explanations include cultural differences why men may not seek care or accept disability or disease. Hispanic men in the Colonias are involved in more physical labor, their diet is calorically high, and aside from work, they do not participate in a planned exercise program. Women may suffer from more adverse psychosocial stressors at a young age (as seen by the five domains of the Duke Profile that measure dysfunction). Teen pregnancy, large families, intimate partner violence, and women's role in the family structure may explain variance in Frailty in younger women. We did not measure education level, alcohol, and substance abuse, tobacco use, social determinants of health, or adverse childhood events that could potentially change the Frailty Index.
It is also interesting that Cameron Park residents not only score higher Frailty Indices at an earlier age but deteriorate quicker than Indian Hills residents. Maybe living in an area within a city exposes residents to worse food choices, social isolation, social vulnerability, or housing insecurity, that Cameron Park has a higher relative in-equality, or that city living includes less nutritious food choices. The rate of decline in Frailty in Cameron Park may relate to social factors, overall age, job types, immigration status, and increased availability to high caloric foods that contribute to the advanced decline. Residents of Indian Hills may retain more of their traditional diet, whereas by comparison Cameron Park has adopted unhealthier modernized/urbanized dietary practices (e.g., fast food, junk food, unprecedented access to sugary drinks).