Original Study| Volume 19, ISSUE 12, P1099-1103, December 2018

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Social Frailty Predicts Incident Disability and Mortality Among Community-Dwelling Japanese Older Adults



      To determine the prevalence of social frailty and its relation to incident disability and mortality in community-dwelling Japanese older adults.


      Prospective cohort study.

      Setting and Participants

      6603 community-dwelling adults aged 65 years and older who were living independently in a city in Shiga prefecture in 2011.


      The outcomes were incident disability and mortality. We defined incident disability using new long-term care insurance (LTCI) service requirement certifications, and the follow-up period was 6 years after the mailed survey.


      The 4-item social frailty screening questionnaire was developed and included general resources, social resources, social behavior, and fulfillment of basic social needs. We categorized the respondents into 3 groups based on the level of social frailty. Additionally, we assessed physical/psychological frailty by the frailty screening index and other demographic variables.


      The prevalences of social frailty, social prefrailty, and social robust were 18.0%, 32.1%, and 50.0%, respectively. During the 6-year follow-up period, 28.1% of those with social robust, 36.9% of those with social prefrailty, and 48.5% of those with social frailty died or experienced incident disability. Those with social prefrailty [adjusted hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.16-1.41] and social frailty (adjusted HR 1.71, 95% CI 1.54-1.90) had significantly elevated risks for incident disability and mortality based on multivariate analyses that used social robust as the reference. Furthermore, the combination of social frailty and physical/psychological frailty is more likely to result in incident disability and mortality compared to social frailty or physical/psychological frailty alone.


      Community-dwelling older adults with both social frailty and physical/psychological frailty are at higher risk of death or disability over 6 years than are older adults with only one type of frailty or no frailty. Screening and preventive measures for social frailty are suggested for healthy aging.


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        • Fried L.P.
        • Tangen C.M.
        • Walston J.
        • et al.
        Frailty in older adults: Evidence for a phenotype.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
        • Satake S.
        • Shimada H.
        • Yamada M.
        • et al.
        Prevalence of frailty among community-dwellers and outpatients in Japan as defined by the Japanese version of the Cardiovascular Health Study criteria.
        Geriatr Gerontol Int. 2017; 17: 2629-2634
        • Ensrud K.E.
        • Ewing S.K.
        • Taylor B.C.
        • et al.
        Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women.
        Arch Intern Med. 2008; 168: 382-389
        • Makizako H.
        • Shimada H.
        • Doi T.
        • et al.
        Impact of physical frailty on disability in community-dwelling older adults: A prospective cohort study.
        BMJ Open. 2015; 5: e008462
        • Makizako H.
        • Shimada H.
        • Doi T.
        • et al.
        Physical frailty predicts incident depressive symptoms in elderly people: Prospective findings from the Obu Study of Health Promotion for the Elderly.
        J Am Med Dir Assoc. 2015; 16: 194-199
        • Yamada M.
        • Arai H.
        Predictive value of frailty scores for healthy life expectancy in community-dwelling older Japanese adults.
        J Am Med Dir Assoc. 2015; 16: 1002.e7-1002.e11
        • Rockwood K.
        What would make a definition of frailty successful?.
        Age Ageing. 2005; 34: 432-434
        • Sugimoto T.
        • Sakurai T.
        • Ono R.
        • et al.
        Epidemiological and clinical significance of cognitive frailty: A mini review.
        Ageing Res Rev. 2018; 44: 1-7
        • Garre-Olmo J.
        • Calvó-Perxas L.
        • López-Pousa S.
        • et al.
        Prevalence of frailty phenotypes and risk of mortality in a community-dwelling elderly cohort.
        Age Ageing. 2013; 42: 46-51
        • Teo N.
        • Gao Q.
        • Nyunt M.S.Z.
        • et al.
        Social frailty and functional disability: Findings from the Singapore Longitudinal Ageing Studies.
        J Am Med Dir Assoc. 2017; 18: 637.e13-637.e19
        • Makizako H.
        • Shimada H.
        • Tsutsumimoto K.
        • et al.
        Social frailty in community-dwelling older adults as a risk factor for disability.
        J Am Med Dir Assoc. 2015; 16: 1003.e7-1003.e11
        • Makizako H.
        • Shimada H.
        • Doi T.
        • et al.
        Social frailty leads to the development of physical frailty among physically non-frail adults: A four-year follow-up longitudinal cohort study.
        Int J Environ Res Public Health. 2018; 15: E490
        • Bunt S.
        • Steverink N.
        • Olthof J.
        • et al.
        Social frailty in older adults: A scoping review.
        Eur J Ageing. 2017; 14: 323-334
        • Chiao C.1
        • Weng L.J.
        • Botticello A.L.
        Social participation reduces depressive symptoms among older adults: An 18-year longitudinal analysis in Taiwan.
        BMC Public Health. 2011; 11: 292
        • Okura M.
        • Ogita M.
        • Yamamoto M.
        • et al.
        Community activities predict disability and mortality in community-dwelling older adults.
        Geriatr Gerontol Int. 2018; 18: 1114-1124
        • Muraki S.
        • Oka H.
        • Akune T.
        • et al.
        Prevalence of radiographic knee osteoarthritis and its association with knee pain in the elderly of Japanese population-based cohorts: The ROAD study.
        Osteoarthritis Cartilage. 2009; 17: 1137-1143
        • Abe T.
        • Thiebaud R.S.
        • Loenneke J.P.
        Age-related change in handgrip strength in men and women: Is muscle quality a contributing factor?.
        Age (Dordr). 2016; 38: 28
        • Woo J.
        • Leung J.
        • Kwok T.
        BMI, body composition, and physical functioning in older adults.
        Obesity (Silver Spring). 2007; 15: 1886-1894
        • Kanamori S.
        • Kai Y.
        • Aida J.
        • et al.
        Social participation and the prevention of functional disability in older Japanese: the JAGES cohort study.
        PLoS One. 2014; 9: e99638
        • Hikichi H.
        • Kondo N.
        • Kondo K.
        • et al.
        Effect of a community intervention programme promoting social interactions on functional disability prevention for older adults: Propensity score matching and instrumental variable analyses, JAGES Taketoyo study.
        J Epidemiol Community Health. 2015; 69: 905-910
        • Yamada M.
        • Arai H.
        Self-management group exercise extends healthy life expectancy in frail community-dwelling older adults.
        Int J Environ Res Public Health. 2017; 14: E531