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Frailty in ethnic minority women

  • Natasha Reid
    Correspondence
    Corresponding author at: Centre for Health Services Research, The University of Queensland, Level 2, Building 33, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba Queensland 4121, Australia
    Affiliations
    Faculty of Medicine, The University of Queensland, Queensland, Australia
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  • Shavini Weerasekera
    Affiliations
    Faculty of Medicine, The University of Queensland, Queensland, Australia

    Princess Alexandra Hospital, Metro South Health Hospital and Health Service, Queensland, Australia

    School of Medicine, Griffith University, Queensland, Australia
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  • Ruth E Hubbard
    Affiliations
    Faculty of Medicine, The University of Queensland, Queensland, Australia

    Princess Alexandra Hospital, Metro South Health Hospital and Health Service, Queensland, Australia
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  • Emily H Gordon
    Affiliations
    Faculty of Medicine, The University of Queensland, Queensland, Australia

    Princess Alexandra Hospital, Metro South Health Hospital and Health Service, Queensland, Australia
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      Highlights

      • A sex–frailty paradox exists, where females tend to be more frail but live longer than males.
      • Frailty in ethnic minority women is likely exacerbated by health inequalities and other factors.
      • While the evidence on frailty in ethnic minority women is sparse and mostly from cross-sectional and cohort studies, we conclude that ethnic minority women are an extremely vulnerable group.
      • The biopsychosocial factors that are most likely to be influential in the development of frailty in ethnic minority women are not immutable, and culturally appropriate and targeted strategies have the potential to positively impact outcomes.
      • Efforts to impact the trajectory of frailty and vulnerability in ethnic minorities need to have a global-level and population-level approaches, and should incorporate individual-level interventions.
      • Future research should focus on understanding the impact of interventions across races and ethnicities.

      Abstract

      In majority populations in high- and middle-income countries, women live longer yet experience higher levels of frailty than men of the same age. It is unclear whether this ‘sex–frailty paradox’ is present in ethnic minority populations. In this narrative review, we explore biological, behavioural and social factors associated with mortality, morbidity and frailty in women, particularly ethnic minority women. We ascertain that natural menopause occurs earlier in women of particular ethnicities. Ethnic minority women (living in high-income countries) have more children and higher rates of chronic disease and disability, all of which are associated with frailty. In some ethnic minorities, women are less likely to engage in deleterious health behaviours such as smoking and alcohol consumption. However, in others the reverse is true. Women from migrant ethnic minorities tend to have lower levels of physical activity. With time, they can also adopt adverse behavioural patterns of the majority population. Although the evidence is sparse, sex differences in health reporting and social assets, as well as gender roles, are likely to contribute to sex differences in frailty in ethnic minorities. Overall, ethnic minority women are a particularly vulnerable group, but the majority of risk factors for frailty appear to be mutable rather than fixed. Future research may examine interventions that target frailty in different races and ethnicities at individual, population and global levels.

      Keywords

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