Social frailty and longitudinal risk of depressive symptoms in a Chinese population: the Rugao Longevity and Aging Study

Longitudinal Relationship Between Baseline Social Frailty and Cognitive Impairment in Older Adults: 14-Year Follow-Up Results From the Korean Longitudinal Study of Ageing

OBJECTIVES

This study aimed to investigate the longitudinal relationship between social frailty and cognitive impairment among community-dwelling older adults.

DESIGN

This retrospective cohort study is based on the first to eighth waves of the Korean Longitudinal Study of Ageing (2006-2020).

SETTING AND PARTICIPANTS

The participants were 2106 community-dwelling older adults aged 65 years or older and without cognitive impairment in 2006.

METHODS

Social frailty was assessed with 5 items including social support, social activity, social network, loneliness, and living alone (0 = social nonfrailty, 1 = social prefrailty, 2 or more = social frailty). Cognitive function was assessed using the Korean Mini-Mental State Examination, and scores below 24 indicated cognitive impairment. We used the generalized estimating equation to assess the longitudinal relationship between social frailty and cognitive impairment.

RESULTS

Of the 2106 participants, 515 (24.4%) had social frailty, 669 (31.8%) had social prefrailty, and 922 (43.8%) were social nonfrailty based on the baseline assessments. Relative to the social nonfrailty group, the odds ratios of the social prefrailty and social frailty groups for cognitive impairment were 1.30 (95% CI 1.10-1.54) and 1.41 (95% CI 1.16-1.71), respectively, during the follow-up. Subgroup analysis showed that social inactivity and loneliness were significantly associated with cognitive impairment.

CONCLUSIONS AND IMPLICATIONS

These findings highlight the need for health care providers to introduce and use available social resources for older adults with social frailty to increase the relationships between individual and social context. Social inactivity and loneliness were the major domains associated with cognitive impairment, and loneliness can be resolved by participating in social activities. Therefore, health care providers especially provide opportunities for social activities, such as group-based programs in the community, to reduce social frailty and cognitive impairment.

Predictive role of depressive symptoms on frailty and its components in Chinese middle-aged and older adults: a longitudinal analysis

BACKGROUND

To investigate the cross-sectional and longitudinal associations between depressive symptoms and the prevalence of frailty and its components in a nationally representative sample of middle-aged and older Chinese adults.

METHOD

The China Health and Retirement Longitudinal Study (CHARLS) provided data on 2581 (after inclusion and exclusion criteria) adults aged ≥ 45 years. Every two years, face-to-face, computer-aided personal interviews (CAPI), and structured questionnaires were used to follow up with the respondents. The Chinese version of the Center for Epidemiologic Studies-Depression Scale (CES-D) was used to evaluate depressive symptoms, and the Fried criteria were used to measure frailty. The odds ratio (OR) and 95% confidence interval (CI) for the association of exposure (depressive symptoms at baseline) with the onset of the outcome (frailty and its components) in the individuals at baseline were analyzed by binary logistic regression.

RESULTS

At baseline, 11.62% of participants had frailty, and 57.92% had depressive symptoms. In the cross-sectional analysis, depressive symptoms (OR = 5.222, 95%CI 3.665-7.442) were associated with frailty. In the longitudinal analysis, after adjusting for the full set of covariates among participants free of baseline frailty, depressive symptoms were significantly associated with incident frailty during the short term (OR = 2.193, 95%CI 1.324-3.631) and the long term (OR = 1.926, 95%CI 1.021-3.632). Meanwhile, depressive symptoms were associated with an increased risk of weakness (OR = 1.990, 95%CI 1.250-3.166), slowness (OR = 1.395, 95%CI 1.044-1.865), and exhaustion (OR = 2.827, 95%CI 2.150-3.719) onset during the short-term. Depressive symptoms were associated with an increased risk of exhaustion (OR = 2.869, 95%CI 2.004-4.109) onset during the long-term.

CONCLUSION

Among middle-aged and older adults, depressive symptoms could predict frailty during 2 years of follow-up and 4 years of follow-up. When considering potential confounding factors, depressive symptoms were considered a predictor of weakness, slowness, and exhaustion. Interventions aimed at preventing depressive symptoms may be beneficial in reducing frailty and its components.

Trends in the Assessment of Social Frailty in Community-Dwelling Older Adults: A Scoping Review

Assessment of social frailty is crucial; however, definitions and assessment methods lack standardization. This review examined social frailty in community-dwelling older adults, highlighted trends in the definitions and assessment items used to date, and identified issues in assessing social frailty. The PubMed and CINAHL databases were searched for articles related to social frailty published up to 2022, and 95 articles were included in this review. The Bunt classification was used to assess the trends in items considered indicative of social frailty. Existing rating scales for social frailty were used in 82% of studies, and cut-off values were defined in 62% of studies. Factors such as the level of education; social interaction (weekly outings); and feelings of abandonment, emptiness, and lack of social integration (absence of a partner and non-participation in social organizations or activities) were evaluated less frequently. This study revealed that subjective feelings, including the fulfillment of social needs and participation in social activities, are less commonly considered in the assessment of 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.

Social frailty and the incidence of motoric cognitive risk syndrome in older adults

INTRODUCTION

Various associations between social factors and motoric cognitive risk syndrome (MCR) have been reported. However, whether social frailty (integrated from multiple social factors) is associated with MCR is still unclear.

METHODS

We included 4657 individuals without MCR at Round 1 of the NHATS as the discovery sample, and 3075 newly recruited individuals from Round 5 of the NHATS as the independent validation sample. Social frailty was assessed by five social items. MCR was defined as the presence of both subjective cognitive complaints and slow gait speed in individuals without dementia or mobility disability.

RESULTS

Compared with normal individuals, those with social frailty had higher risk of incident MCR (hazard ratio [HR]: 1.57, 95% confidence interval [CI]: 1.34-1.84). Each additional unfavorable social item was associated with an increased risk of MCR (HR: 1.32, 95% CI: 1.22-1.43).

DISCUSSION

Social frailty was associated with an increased risk of incident MCR in older adults.

HIGHLIGHTS

Various associations between social factors and motoric cognitive risk syndrome (MCR) have been reported. Social frailty that integrated from multiple social factors was associated with an increased risk of incident MCR. Social frailty should be included in the early screening of individuals to identify those at higher risk of MCR.

Predictive Role of Depressive Symptoms on Frailty and its Components in Chinese Middle-Aged and Older Adults: a Longitudinal Analysis

Background

To investigate the cross-sectional and longitudinal associations between depressive symptoms and the prevalence of frailty and its components in a nationally representative sample of middle-aged and older Chinese adults.

Method

The China Health and Retirement Longitudinal Study (CHARLS) provided data on 17,104 adults aged ≥ 45 years. Every two years, face-to-face, computer-aided personal interviews (CAPI), and structured questionnaires were used to follow up with the respondents. The Chinese version of the Center for Epidemiologic Studies-Depression Scale (CES-D) was used to evaluate depressive symptoms, and the Fried criteria were used to measure frailty. The odds ratio (OR) and 95% confidence interval (CI) for the cross-sectional connections among depressive symptoms and frailty and its components in the individuals at baseline were analyzed using logistic regression. A Cox proportional hazards analysis was performed using the hazard ratio (HR) and 95% confidence interval for the prospective connection between baseline depressive symptoms and frailty and its component in the participants without frailty at baseline.

Results

At baseline, 11.62% of participants had frailty, and 57.92% had depressive symptoms. In the cross-sectional analysis, depressive symptoms (OR = 5.222, 95%CI 3.665-7.442) were associated with frailty. In the longitudinal analysis, after adjusting for the full set of covariates among participants free of baseline frailty, depressive symptoms were significantly associated with incident frailty during the short term [HR = 2.193 (1.324-3.631)] and the long term [HR = 1.926 (1.021-3.632)]. Meanwhile, depressive symptoms were associated with an increased risk of weakness [HR = 1.990 (1.250-3.166)], slowness [HR = 1.395 (1.044-1.865)], and exhaustion [HR = 2.827 (2.150-3.719)] onset during the short-term. Depressive symptoms were associated with an increased risk of exhaustion [HR = 2.869 (2.004-4.109)] onset during the long-term.

Conclusion

Among middle-aged and older adults, depressive symptoms could predict frailty during 2 years of follow-up and 4 years of follow-up. When considering potential confounding factors, depressive symptoms were considered a predictor of weakness, slowness, and exhaustion. Interventions aimed at preventing depressive symptoms may be beneficial in reducing frailty and its components.

Association Between Social Frailty and Life Satisfaction Among Older Adults: The Role of Functional Limitations and Depressive Symptoms

The current study aimed to identify life satisfaction depending on the degree of social frailty and explore the mediating role of functional limitations and depressive symptoms between social frailty and life satisfaction. A secondary analysis of a cross-sectional survey was used. Data of 6,479 older adults were selected from the 2020 National Survey of Older Koreans. Of all participants, 2,595 (40.1%) and 1,605 (24.8%) had social prefrailty and frailty, respectively. Life satisfaction of participants with social frailty was significantly worse than those without social frailty. Social frailty negatively influenced life satisfaction. Functional limitations and depressive symptoms serially mediated the association between social frailty and life satisfaction. This mediation model provided evidence of the associations among social frailty, functional limitations, depressive symptoms, and life satisfaction in older adults. In community care settings, nurses should recognize the assessment of social frailty to enhance the subjective well-being of older adults. [Research in Gerontological Nursing, 16(6), 291-300.].

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

BACKGROUND

With the aging of the population, frailty has attracted much attention, and the social dimension of frailty, namely social frailty, has also attracted attention. Studies have shown that social frailty can bring some adverse effects to the elderly, such as physical and cognitive function.

AIMS

To explore the risk of adverse health outcomes in older adults with social frailty compared with older adults with non-social frailty.

METHODS

Five databases were systematically searched from inception to February 28, 2023. Screening, data extraction and quality assessment were conducted independently by two researchers. The included studies were longitudinal studies of adverse outcomes in community-dwelling socially frail older adults, and the quality of each study was assessed using the Newcastle‒Ottawa Scale.

RESULTS

A total of 15 studies were included based on the inclusion criteria, of which 4 were subjected to meta-analysis. The mean age of the included population ranged from 66.3 to 86.5 years. According to existing research, social frailty was predictive of some adverse outcomes, such as incident disability, depressive symptoms, and reduced neuropsychological function. The meta-analysis showed that social frailty had a significant predictive effect on mortality among older adults [HR = 2.27, (95% CI = 1.03-5.00)].

CONCLUSION

In community-dwelling older adults, social frailty was a predictor of mortality, incident disability, depressive symptoms and other adverse outcomes. Social frailty had a negative impact on older adults, so it was necessary to strengthen the screening of social frailty to reduce the incidence of adverse outcomes.

The Prevalence of Social Frailty Among Older Adults: A Systematic Review and Meta-Analysis

OBJECTIVE

To report the overall prevalence of social frailty among older people and provide information for policymakers and authorities to use in developing policies and social care.

DESIGN

A systematic review and meta-analysis.

SETTING AND PARTICIPANTS

We searched 4 databases (PubMed, Embase, Web of Science, and Google Scholar) to find articles from inception to July 30, 2022. We included cross-sectional and cohort studies that provided the prevalence of social frailty among adults aged 60 years or older, in any setting.

METHODS

Three researchers independently reviewed the literature and retrieved the data. A risk of bias tool was used to assess each study's quality. A random-effect meta-analysis was performed to pool the data, followed by subgroup analysis, sensitivity analysis, and meta-regression.

RESULTS

From 761 records, we extracted 43 studies with 83,907 participants for meta-analysis. The pooled prevalence of social frailty in hospital settings was 47.3% (95% CI: 32.2%-62.4%); among studies in community settings, the pooled prevalence was 18.8% (95% CI: 14.9%-22.7%; P < .001). The prevalence of social frailty was higher when assessed using the Tilburg Frailty Indicator (32.3%; 95% CI: 23.1%-41.5%) than the Makizako Social Frailty Index (27.7%; 95% CI: 21.6%-33.8%) or Social Frailty Screening Index (13.4%; 95% CI: 8.4%-18.4%). Based on limited community studies in individual countries using various instruments, social frailty was lowest in China (4.9%; 95% CI: 4.2%-5.7%), followed by Spain (11.6%; 95% CI: 9.9%-13.3%), Japan (16.2%; 95% CI: 12.2%-20.3%), Korea (26.6%; 95% CI: 7.1%-46.1%), European urban centers (29.2%; 95% CI: 27.9%-30.5%), and the Netherlands (27.2%; 95% CI: 16.9%-37.5%). No other subgroup analyses showed any statistically significant prevalence difference between groups.

CONCLUSION AND IMPLICATIONS

The prevalence of social frailty among older adults is high. Settings, country, and method for assessing social frailty affected the prevalence. More valid comparisons will await consensus on measurement tools and more research on geographically representative populations. Nevertheless, these results suggest that public health professionals and policymakers should seriously consider social frailty in research and program planning involving older adults.

The prevalence of social frailty among older adults: A systematic review and meta-analysis

Social frailty is a geriatric public health problem that deeply affects healthy aging. Currently, evidence on the prevalence and factors associated with social frailty in older adults remains unclear. Our study aims to estimate the prevalence and related factors of social frailty in older adults. This study retrieved nine electronic databases searched through July 5th, 2022. The prevalence of social frailty was pooled using Stata software. It was found that older adults suffered from a "moderate" level of social frailty. We found a higher prevalence of social frailty in the United Kingdom, Greece, Croatia, The Netherlands, and Spain, in people over 75 years, in hospitals, and during the Coronavirus Disease 2019 (COVID-19). We believed that countries, age, research sites, and the pandemic of COVID-19 were influencing factors of social frailty among older adults. These findings may provide a theoretical basis for the development of ameliorating social frailty among older adults.

The Relationship between Social Frailty and Depressive Symptoms in the Elderly: A Scoping Review

BACKGROUND

Various studies have highlighted the correlation between social frailty and depressive symptoms in the elderly. However, evidence of how these two domains influence each other is not clear. The purpose of this scoping review is to summarize the current literature examining social frailty and depressive symptoms.

METHOD

We conducted a scoping review allowing for the inclusion of multiple methodologies to examine the extent and range of this research topic.

RESULT

The search initially yielded 617 results, 14 of which met the inclusion criteria. Five studies were identified from China, six were identified from Japan, two were identified from Korea, one was identified from Ghana, and one was from Asia. The evidence reviewed indicated that five studies met category 5 criteria, and the others met level 3 criteria. The findings from these studies showed that there is a significant relationship between social frailty and depressive symptoms.

CONCLUSION

This scoping review shows that worse social frailty contributes to a significant degree of depression. Further research on screening social frailty and possible interventions in community and medical settings to prevent the elderly from developing depressive symptoms is needed.

Natural population cohort study on long-lived adults: West China longevity and ageing procedure (WCLAP)

PURPOSE

The West China longevity and ageing procedure (WCLAP) cohort study aims to provide guidance for older adults in western China with the aim of improving quality of life, reducing the burden of family care, summarising the characteristics of longevity lifestyles, building a Chinese-longevity-population biobank and exploring the mechanisms underlying population ageing.

PARTICIPANTS

Since the establishment of the WCLAP research baseline in 2018, a population of 1537 adults aged 80 years and above, living in the community, have been enrolled in the programme as research participants. Of these, 231 are aged 100 years and above. Participants are followed up every year.

FINDING TO DATA

WCLAP data are collected in five hospital research subcentres strategically located adjacent to the national 'Longevity Townships' of Chengdu Ziyang, Leshan, Yibin and Pengshan. Data collection included a comprehensive assessment of the participant's health (including physical, psychological, social and common chronic disease assessments), instrumental tests (body composition and muscle percentage) and the collection of biomedical-biobank samples (include blood, urine, faeces, hair and urine).

FUTURE PLANS

Through the annual cohort follow-up, survival-related information is collected at a group level. Analysis of biological samples facilitates biological characterisation at the microscopic level through proteomics, metabolomics, genomics and other techniques. Baseline data, group-level follow-up data and microbiological examination data are integrated together to provide an evaluation tool, exploring sarcopenia, disability, dementia, caregiver burden, ageing biomarkers and other influencing factors.

TRIAL REGISTRATION NUMBERS

2018-463; ChiCTR1900020754.

How Does Ageing Affect Social Attention? A Test of Competing Theories using Multi-Level Meta-Analysis

Objectives

The present study provides a meta-analytic assessment of how gaze-cued attention—a core social-cognitive process—is influenced by normal adult aging.

Methods

A multilevel meta-analysis of standardized mean changes was conducted on gaze-cueing effects. Age effects were quantified as standardized mean differences in gaze-cueing effect sizes between young and older adult samples.

Results

We identified 82 gaze-cueing effects (k = 26, N = 919 participants). Of these, 37 were associated with young adults (k = 12, n = 438) and 45 with older adults (k = 14, n = 481). Relative to younger adults, older adults had a reduced gaze-cueing effect overall, g = −0.59, with this age effect greater when the cues were predictive, g = −3.24, rather than nonpredictive, g = −0.78.

Discussion

These results provide the clearest evidence to date that adult aging is associated with a reduction in gaze-cued attention. The results also speak to potential mechanisms of this age effect. In line with cognitive decline models of aging, it was demonstrated that when gaze cues were predictive, only younger adults seem to benefit, suggesting that older adults exhibit a particularly reduced capacity to use gaze cues volitionally.

Osteosarcopenia, the co-existence of osteoporosis and sarcopenia, is associated with social frailty in older adults

BACKGROUND

Osteosarcopenia is a newly described, aging-associated condition. Social frailty is an important condition whose prevalence may have risen by physical distancing during the coronavirus disease 2019 pandemic. However, the relationship between these two remains unclear.

AIMS

To examine the association between osteosarcopenia and social frailty.

METHODS

This cross-sectional study was conducted using data from outpatients visiting general geriatric hospital frailty clinics. Bone mineral density (BMD) and muscle mass were measured using dual X-ray absorptiometry. Osteoporosis was defined as a BMD of < 70% of the young adult mean, according to the Japan Osteoporosis Society. Sarcopenia was diagnosed as per the Asian Working Group for Sarcopenia 2019 recommendation. Osteosarcopenia was defined as the co-existence of osteoporosis and sarcopenia. We defined social frailty using a questionnaire comprising four items: general resources, social resources, social behavior, and basic social needs. Ordinal logistic regression analysis was performed with social frailty status and osteosarcopenia as the dependent and independent variables, respectively.

RESULTS

We included 495 patients (mean age = 76.5 ± 7.2 years) in the analysis; of these, 58.2% were robust and 17.2%, 13.5%, and 11.1% had osteoporosis alone, sarcopenia alone, and osteosarcopenia, respectively. Social frailty prevalence increased stepwise from 8.0% in robust patients to 11.8%, 17.9%, and 29.1% among those with osteoporosis alone, sarcopenia alone, and osteosarcopenia, respectively (P < 0.001). Logistic regression analysis revealed that only osteosarcopenia was significantly associated with social frailty (pooled odds ratio: 2.117; 95% confidence interval: 1.104-4.213).

DISCUSSION

Comprehensive assessment of osteosarcopenia and social frailty is needed for disability prevention in older adults.

Social frailty is independently associated with geriatric depression among older adults living in northern Japan: A cross-sectional study of ORANGE registry

AIM

To clarify prevalence of social frailty among older adults living in a rural Japanese community, and factors associated with social frailty status.

METHODS

In total, 322 adults aged ≥65 years living in a Japanese rural community took part in the study from 2018 to 2020. Social frailty was defined as deficiencies of: (i) living alone; (ii) talking with someone every day; (iii) feeling helpful to friends or family; (iv) going out less frequently compared with last year; and (v) visiting friends sometimes. Social frail status was categorized as robust (0), social prefrail (1), and social frail (≥2), according to the summated score of Makizako's criteria. Multiple logistic regression analysis was applied to clarify factors associated with social frailty status.

RESULTS

Final samples were classified into 68 persons with social frailty, 98 persons with social prefrailty and 147 persons as robust. We observed the prevalence of social frailty (21.7%) and social prefrailty (31.3%) and the GDS-15 had significantly high scores in the social frail groups. Social frailty was significantly associated with the GDS-15 score (odds ratio, 1.33; 95% CI, 1.19-1.49) and TMT-A (odds ratio, 1.04; 95% CI, 1.01-1.08) and GDS-15 (odds ratio, 1.13; 95% CI, 1.03-1.26) were extracted as independent variables of social prefrail status, with adjustment for demographics, polypharmacy and lifestyle-related diseases.

CONCLUSIONS

Our results suggest that social frailty tends to be increasing gradually in a Japanese rural area, and social prefrailty might be potentially associated with attentional function, as well as the GDS-15 score. Geriatr Gerontol Int 2021; ••: ••-••.

Social frailty and depressive symptoms during the COVID-19 pandemic among older adults in Japan: Role of home exercise habits

Objectives

: We examined the association between social frailty and depressive symptoms among community-dwelling older adults during the coronavirus disease 2019 pandemic. Additionally, we investigated whether home exercise habits moderated the impact of social frailty on depressive symptoms.

Methods

: This cross-sectional study included 1,103 community-dwelling older adults (54.0% female, mean age [standard deviation] = 81.1 [5.0] years) from a semi-urban area of Japan who completed a mailed questionnaire survey in October 2020. Social frailty status was categorized as non-social frailty, pre-social frailty, and social frailty, which was assessed by financial difficulties, living alone, lack of social activity, and contact with neighbors. Depressive symptoms were defined as a Kessler 6 score ≥5. We performed a multivariable logistic regression analysis to examine the association between social frailty and depressive symptoms, and also conducted stratified analysis of home exercise habits during the pandemic.

Results

: A total of 309 (28.0%) participants had depressive symptoms. Compared with non-social frailty, social frailty was associated with depressive symptoms (odds ratio [OR] = 1.80, 95% confidence interval [95%CI] = 1.16–2.79, p = 0.009). A similar relationship was observed in those who did not exercise at home (OR = 2.10, 95%CI = 1.14–3.84, p =0.017). However, no such relationship was observed in those who did exercise at home (OR = 1.50, 95%CI = 0.79–2.85, p =0.213).

Conclusions

: Social frailty was associated with a risk of depressive symptoms during the pandemic. In addition, our findings suggested that home exercise may buffer the association between social frailty and depressive symptoms.