Social frailty as a predictor of adverse outcomes among older adults: a systematic review and meta-analysis

Prevalence of social frailty and risk factors among community-dwelling older adults: A systematic review and meta-analysis

BACKGROUND

Older people are more vulnerable to social frailty due to age, physical condition and socio-economic status. Since social frailty can lead to adverse health outcomes, it is essential to understand the current state of social frailty among community-dwelling older adults.

AIMS

To consolidate existing evidence for rates of social frailty and risk factors.

METHODS

Two researchers independently selected studies, extracted data, assessed the quality of the studies included in the literature, and calculated the rate of social frailty through a random-effects model with OR and 95 % CI for risk factors.

RESULTS

The literature search yielded a total of 81,414 articles, with 28 articles ultimately meeting the study criteria and being included in the meta-analysis. The prevalence of social frailty among community-dwelling older adults was 20.0 % (95 % CI 15.0 %-25.0 %, I2 = 99.5 %, P < 0.001). MSFI and other criteria yielded social frailty rates of 20.6 % and 18.3 %, respectively. The rate of social frailty was 20.2 % for the cross-sectional design and 19.3 % for the cohort design. The prevalence of social frailty is 20.2 % in Asian countries and 17.4 % in European countries. The rate of social frailty is 22.0 % for those aged 75 and over and 17.9 % for those under 75. Multiple chronic conditions, a major illness, marital status, sleep quality, and depressive symptoms are associated with social frailty.

CONCLUSION

Social frailty affects nearly one in five community-dwelling older adults, and having multiple chronic conditions, having a major illness, being single, poor sleep quality, and depression are all risk factors for social frailty.

Association between mental health and sleep condition with social frailty: evidence from ardakan cohort study on aging (ACSA)

OBJECTIVE

This population-based study aimed to evaluate the association of mental health and several sleep conditions with Social Frailty (SF) in a sample of Iranian middle-aged and older adults.

METHOD

This cross-sectional study was conducted using data from the Ardakan Cohort Study on Aging (ACSA). SF was assessed by five questions: inability to help others, limited social participation, loneliness, financial difficulty, and not having anyone to talk to (HALFT). Based on the responses, the participants were divided into three groups: social robust (a score of 0), pre-SF (a score of 1-2), and SF (a score of ≥3). Mental health factors included depression and anxiety. Within the domain of sleep conditions, considerations included sleep duration, quality, subjective sleep health, and daytime sleepiness. The logistic regression models were employed to analyze the data.

RESULTS

A total of 5782 subjects participated in the study, with females comprising 50.7% of the sample. This study revealed the total prevalence of pre-SF and SF were 76.4 and 9.3%, respectively. After adjusting for age, sex, marital status, education, number of comorbidities, and mental health, in the age group of 50-60 years, anxiety (borderline and abnormal compared to normal, OR = 1.49, 95% CI: 1.05-2.11 and OR = 1.98, 95% CI: 1.26-3.12, respectively) were associated with SF. Similarly, in the age group of 60 years and above, only depression was associated with SF (OR = 2.24, 95% CI: 1.45-3.44).

CONCLUSION

These findings imply that mental health might contribute to SF in the middle-aged and older Iranian population.

Joint trajectories of physical frailty and social frailty and associations with adverse outcomes: A prospective cohort study

BACKGROUND

We examined joint trajectories of physical frailty and social frailty as well as their associations with adverse outcomes.

METHODS

We conducted a prospective cohort study by using five waves of national data from China Health and Retirement Longitudinal Study (CHARLS 2011-2020), involving 4531 participants aged ≥60 years. We identified 4-year trajectories at three examinations from 2011 to 2015 using parallel process latent class growth analysis. Adverse outcomes were obtained from 2015 to 2020 across two subsequent waves. We calculated hazard ratios (HR) using Cox proportional hazard models. We also conducted analyses by gender.

RESULTS

Three joint trajectories were identified, including persistent absence of physical and social frailty (58.5 %), no physical frailty but social frailty (28.1 %), and persistent combination of physical and social frailty (13.4 %). Compared with persistent absence of physical and social frailty, no physical frailty but social frailty and persistent combination of physical and social frailty were associated with higher risk of instrumental activities of daily living (IADL) disability (HR = 1.182-2.020, 95 % CI: 1.014-2.416) and all-cause mortality (HR = 1.440-2.486, 95 % CI: 1.211-3.009). The persistent combination of physical and social frailty was also associated with ADL disability (HR = 2.412, 95 % CI: 1.999-2.911) and falls (HR = 1.410, 95 % CI: 1.196-1.662). Gender differences were observed in relationships between joint trajectories and adverse outcomes.

CONCLUSION

Community-dwelling older adults exhibit distinct joint trajectories and those with persistent combination of physical and social frailty experience greatest risk of incident adverse outcomes. Clinical and public health measures targeting physical or social frailty should account for both and be gender-specific.

Short functional geriatric evaluation: Confirmatory factor analysis to assess the multidimensionality of frailty in community-dwelling older adults

This paper explores the ageing population in Italy, where older adults account for more than 14 million individuals (in January 2023) and constitute 24.1 % of the total population. Frailty, a condition encompassing biological, psychological, social, and economic challenges, is recognised as a significant public health issue. The study introduces the Short Functional Geriatric Evaluation (SFGE) as a large-scale screening tool for frailty in community-dwelling older individuals. A Confirmatory Factor Analysis (CFA) was conducted on the SFGE. The CFA scrutinises the construct validity of SFGE using a sample population from the "Long Live the Elderly!" program in Italy. Initial results indicate an acceptable fit, prompting the incorporation of Modification Indices to enhance model performance. The refined CFA demonstrates that the SFGE model effectively captures the multidimensional nature of frailty. The text underscores the timeliness of identifying frailty, emphasising the need for simple, fast, and predictive tools to screen large populations efficiently.

The impact of frailty on clinical outcomes among older adults with diabetes: A systematic review and meta-analysis

BACKGROUND

Frailty has been identified as a risk factor for adverse outcomes in older adults with diabetes. This study aimed to investigate the impact of frailty on the prognosis of older adults with diabetes through a systematic review and meta-analysis, with the goal of offering insights for clinical decision-making.

METHODS

PubMed, Web of Science, Embase, Cochrane were systematically searched from inception to September 10th, 2023. Reviewers independently selected studies, extracted data and evaluated the quality of studies. Stata 15.1 Software was used to perform the meta-analysis. The primary outcomes of this study were mortality, hospitalization and disability, and the secondary outcomes were diabetes complications (including nephropathy, microvascular complications, macroangiopathy, cardiovascular events, hypoglycemia) and urolithiasis.

RESULTS

A total of 14 studies were included in this study, with low risk of bias and moderate to good quality. The results showed that frailty increased the risk of mortality (HR 1.91, 95% CI 1.55-2.35, P < .001), hospitalization (HR 2.19, 95% CI 1.53-3.13, P < .001), and disability in older adults with diabetes (HR 3.84, 95% CI 2.35-6.28, P < .001). In addition, frailty was associated with diabetes complications (including nephropathy, microvascular complications, macroangiopathy, cardiovascular events, hypoglycemia), urolithiasis.

CONCLUSIONS

Frailty is an important predictor of adverse outcomes, such as mortality, hospitalization, and disability in older adults with diabetes. Accurate assessment of the frailty in older adults with diabetes can help improve the adverse outcomes of patients.

Medical care priorities of community-dwelling older adults according to three dimensions of quality of life: Quality of daily living, satisfaction and happiness from birth to death, and human vitality

AIM

Although the maintenance and improvement of quality of life (QoL) through holistic care are important in geriatric medical care, care priorities might differ depending on three essential aspects of QoL: the quality of daily living, satisfaction and happiness from birth to death, and human vitality, which are "Seikatsu," "Jinsei," "Seimei" in Japanese, respectively. We aimed to clarify these priorities in terms of medical care and examined how the definitions of QoL affected these priorities' rankings.

METHODS

This cross-sectional study involved community-dwelling older adults aged ≥65 years living in Kashiwa City, Chiba Prefecture, Japan. The number of participants was 1550 (mean age, 76.1 ± 5.8 years; 699 women [45.1%]). A self-administered questionnaire distributed in advance was used to rank 12 items sought in medical care. Participants were randomly assigned to one of three groups and sent the corresponding questionnaire, which differed only in the definition of QoL.

RESULTS

The top priorities for medical care were "effective treatment of illness," "improvement of physical function," and "maintaining a high level of activity." When QoL was defined as "the quality of daily living, satisfaction and happiness from birth to death, and human vitality," participants were significantly more likely to rank QoL improvement as one of the top three items (adjusted odds ratio, 1.46; 95% confidence interval, 1.03-2.05).

CONCLUSIONS

As a medical care priority, older adults desire improvement of multidimensional elements of life, including human vitality. Health care providers should consider this when making medical care decisions. Geriatr Gerontol Int 2024; 24: 493-498.

Conservative Management in End-Stage Kidney Disease between the Dialysis Myth and Neglected Evidence-Based Medicine

In the last few decades, the aging of the general population has significantly increased the number of elderly patients with end-stage kidney disease (ESKD) who require renal replacement therapy. ESKD elders are often frail and highly comorbid with social issues and seem to not benefit from dialysis in terms of survival and quality of life. Conservative management (CM) could represent a valid treatment option, allowing them to live for months to years with a modest impact on their habits. Despite these possible advantages, CM remains underused due to the myth of dialysis as the only effective treatment option for all ESKD patients regardless of its impact on quality of life and survival. Both CM and dialysis remain valid alternatives in the management of ESKD. However, assessing comorbidities, disabilities, and social context should drive the choice of the best possible treatment for ESKD, while in elderly patients with short life expectancies, referring them to palliative care seems the most reasonable choice.

Understanding social frailty

Social frailty, along with physical and psychological frailties, is one of the components of frailty that has been reported to increase the incidence of adverse health outcomes. Although the prevalence of social frailty is relatively high, consensus on how to define and measure it is insufficient. In considering social frailty, living alone, interaction with neighbors, and social participation are important indicators, and interaction with neighbors and social participation, which are modifiable factors, are important countermeasures. The promotion of these social activities will contribute to extending healthy life expectancy-for example, by promoting physical activity. However, older people's physical and social activities have been severely constrained by the coronavirus pandemic since 2020. In the future, it will be necessary to fully understand the characteristics and significance of social frailty and develop appropriate countermeasures.