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Frailty, prefrailty and employment outcomes in Health and Employment After Fifty (HEAF) Study
  1. Keith T Palmer1,2,
  2. Stefania D'Angelo1,2,
  3. E Clare Harris1,2,
  4. Cathy Linaker1,2,
  5. Catharine R Gale1,3,
  6. Maria Evandrou4,
  7. Holly Syddall1,
  8. Tjeerd van Staa5,6,
  9. Cyrus Cooper1,2,
  10. Avan Aihie Sayer1,7,8,9,10,
  11. David Coggon1,2,
  12. Karen Walker-Bone1,2
  1. 1MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
  2. 2Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
  3. 3Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK
  4. 4Centre for Research on Ageing, University of Southampton, Southampton, UK
  5. 5Farr Institute, University of Manchester, Manchester, UK
  6. 6Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
  7. 7NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, UK
  8. 8Institute of Neuroscience, Newcastle University, Newcastle, UK
  9. 9NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle, UK
  10. 10Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
  1. Correspondence to Professor Keith T Palmer, Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; ktp{at}


Objectives Demographic changes are requiring people to work longer. No previous studies, however, have focused on whether the ‘frailty’ phenotype (which predicts adverse events in the elderly) is associated with employment difficulties. To provide information, we assessed associations in the Health and Employment After Fifty Study, a population-based cohort of 50–65-year olds.

Methods Subjects, who were recruited from 24 English general practices, completed a baseline questionnaire on ‘prefrailty’ and ‘frailty’ (adapted Fried criteria) and several work outcomes, including health-related job loss (HRJL), prolonged sickness absence (>20 days vs less, past 12 months), having to cut down substantially at work and difficulty coping with work's demands. Associations were assessed using logistic regression and population attributable fractions (PAFs) were calculated.

Results In all, 3.9% of 8095 respondents were classed as ‘frail’ and 31.6% as ‘prefrail’. Three-quarters of the former were not in work, while 60% had left their last job on health grounds (OR for HRJL vs non-frail subjects, 30.0 (95% CI 23.0 to 39.2)). Among those in work, ORs for prolonged sickness absence, cutting down substantially at work and struggling with work's physical demands ranged from 10.7 to 17.2. The PAF for HRJL when any frailty marker was present was 51.8% and that for prolonged sickness absence was 32.5%. Associations were strongest with slow reported walking speed. Several associations were stronger in manual workers than in managers.

Conclusions Fried frailty symptoms are not uncommon in mid-life and are strongly linked with economically important adverse employment outcomes. Frailty could represent an important target for prevention.

  • job loss
  • frail
  • work limitations

Statistics from


  • Contributors KTP identified the study questions and, with DC, designed the study and its measuring instruments. KTP supervised data collection and, with SD, DC and HS, planned the analyses. SD conducted the analyses. KTP wrote the first draft of the paper. KW-B, SD, ECH, CL, AAS, CRG, ME, HS, TvS and CC contributed to the study's design, content, measuring instruments and plan of execution. Additionally, ECH and CL led in data collection, cleaning and preparation and the enlistment of participating general practices. All authors read and approved the final manuscript.

  • Funding This work was supported by Arthritis Research UK (grant numbers ARC 19817, ARUK 20665); the Medical Research Council and the Economic and Social Research Council jointly (grant number ES/L002663/1); and a Medical Research Council programme grant (number MRC_MC_UP_A620_1018).

  • Competing interests CC has received consultancy fees and honoraria from Alliance for Better Bone Health, Amgen, Eli Lilly, GSK, Medtronic, Merck, Novartis, Pfizer, Roche, Servier, Takeda and UCB.

  • Patient consent Obtained.

  • Ethics approval NHS Research Ethics Committee North West-Liverpool East.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Requests for data sharing should be addressed to the corresponding author.

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