Abstract
Objectives
Older people are often socially deprived, which may predispose them to frailty. The
aim of the study was to identify the independent effects of social deficits and their
combined effects with frailty (“social frailty”) in predicting functional decline,
institutionalization, and mortality in older adults living in the community.
Design
Longitudinal study with a 3-year follow-up.
Setting and Participants
A nationally representative sample of community-dwelling older people aged 65 years
or older in South Korea (N = 11,241).
Methods
Social deficits were defined as deficiencies in socioeconomic status, living situation,
social network size, contact with social networks, social support, and social activities.
The number of social deficits was categorized as none (0), low (1-2), and high (3
or more), based on the summated score. Frailty status was defined using the Fried
criteria. Cox proportional hazards model was used to analyze the effects of the increasing
levels of social deficits on functional decline, institutionalization, and mortality.
The combined effects of both social deficits and physical frailty were also assessed,
controlling for covariates.
Results
The prevalence of frailty was 7.7%, with 49.1% being prefrail at baseline. Overall,
the presence of social deficits tended to elevate the risk of adverse outcomes, where
acquiring 1 social deficit was associated with an 11% to 27% increase in their risks.
In the multivariable analysis, those with a high level of social deficits demonstrated
a significantly elevated mortality risk [hazard ratio (HR) = 1.45, 95% confidence
interval (CI): 1.07, 1.97). There was a trend toward increasing hazards when social
deficits were combined with physical frailty, with the group having a high level of
social deficits and being frail exhibiting the highest mortality risk (HR = 3.14,
95% CI: 1.81, 5.46).
Conclusions and Implications
Social adversity independently predicted mortality. When combined with physical frailty,
an accumulation of social deficits increased the predictive value.
Keywords
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References
- Frailty consensus: A call to action.J Am Med Dir Assoc. 2013; 14: 392-397
- The comprehensive frailty assessment instrument: Development, validity and reliability.Geriatr Nurs. 2013; 34: 274-281
- Current Status of the social Situation, Wellbeing, Participation in Development and Rights of Older People Worldwide.United Nations, New York, NY2011
- Active Ageing: A Policy Framework.World Health Organization, Geneva, Switzerland2002
- How to include the social factor for determining frailty?.J Frailty Aging. 2012; 1: 13-17
- Social vulnerability, frailty and mortality in elderly people.PLoS One. 2008; 3: e2232
- Are physically frail older persons more at risk of adverse outcomes if they also suffer from cognitive, social, and psychological frailty?.Eur J Ageing. 2014; 11: 213-219
- The Tilburg Frailty Indicator: Psychometric properties.J Am Med Dir Assoc. 2010; 11: 344-355
- Social frailty among community-dwelling older adults: Recommended assessments and implications.Ann Geriatr Med Res. 2018; 22: 3-8
- Assessing the social dimension of frailty in old age: A systematic review.Arch Gerontol Geriatr. 2018; 78: 101-113
- The social environment's relationship with frailty: evidence from existing studies.J Appl Gerontol. 2019; 38: 3-26
- Social vulnerability and survival across levels of frailty in the Honolulu-Asia Aging Study.Age Ageing. 2015; 44: 709-712
- 2008 Living Profiles of Older People Survey: A national report on the living status and welfare needs of older adults.Ministry of Health and Welfare, Keimyung University Industry-Academic Cooperation Foundation, Seoul, Republic of Korea2009
- Social frailty in older adults: A scoping review.Eur J Ageing. 2017; 14: 323-334
- Frailty in older adults: Evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
- The validity and reliability of the Korean Activities of Daily Living (K-ADL) scale.J Korean Geriatr Soc. 2002; 6: 98-106
- The validity and reliability of Korean Instrumental Activities of Daily Living (K-IADL) scale.J Korean Geriatr Soc. 2004; 6: 273-280
- Development of the Korean version of the Geriatric Depression Scale and its short form among elderly psychiatric patients.J Psychiatr Res. 2004; 57: 297-305
- A normative study of the Mini-Mental State Examination in the Korean elderly.J. Korean Neuropsychiatr Assoc. 2002; 41: 508-525
- Prevalence of frailty phenotypes and risk of mortality in a community-dwelling elderly cohort.Age Ageing. 2012; 42: 46-51
- Social frailty is associated with physical functioning, cognition, and depression, and predicts mortality.J Nutr Health Aging. 2018; 22: 989-995
- Social frailty predicts incident disability and mortality among community-dwelling Japanese older adults.J Am Med Dir Assoc. 2018; 19: 1099-1103
- Socioeconomic status and mortality in Dutch elderly people: The Rotterdam study.Eur J Public Health. 2000; 10: 255-261
- Socioeconomic factors, health behaviors, and mortality: Results from a nationally representative prospective study of US adults.JAMA. 1998; 279: 1703-1708
- Social relationships and mortality risk: a meta-analytic review.PLoS Med. 2010; 7: e1000316
- Social network epidemiology.in: Berkman L.F. Kawachi I. Glymour M.M. Social Epidemiology. 2nd ed. Oxford University Press, New York, NY2014: 234-289
- Biological pathways linking social conditions and health.in: Berkman L.F. Kawachi I. Glymour M.M. Social epidemiology. 2nd ed. Oxford University Press, New York, NY2014: 512-561
- Health-related and socio-demographic factors associated with frailty in the elderly: A systematic literature review.Cad Saude Publica. 2014; 30: 1143-1168
- 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
- Social frailty in community-dwelling older adults as a risk factor for disability.J Am Med Dir Assoc. 2015; 16: 1003.e1007-1003.e1011
- Social frailty and functional disability: Findings from the Singapore Longitudinal Ageing Studies.J Am Med Dir Assoc. 2017; 18: 637.e613-637.e619
- Poverty rate (indicator). 2018.(Available at:)https://data.oecd.org/inequality/poverty-rate.htmDate accessed: February 26, 2020
- 2017 National survey of older Koreans: findings and implications.Korea Institute for Health and Social Affairs, Sejong, Republic of Korea2018
- Does a social prescribing “holistic” link-worker for older people with complex, multimorbidity improve well-being and frailty and reduce health and social care use and costs? A 12-month before-and-after evaluation.Prim Health Care Res Dev. 2019; 20: e135
- Social prescribing programmes to prevent or delay frailty in community-dwelling older adults.Geriatrics (Basel). 2019; 4
- Community based home visiting service in Korea: City of Gwangmyeong.Aust Nurs Midwifery J. 2017; 24: 38
- Comprehensive community care system to allow elderly Koreans to live in their homes by 2025.(Available at:)http://english.hani.co.kr/arti/english_edition/e_national/871188.htmlDate accessed: February 27, 2020
Article info
Publication history
Published online: May 03, 2020
Footnotes
This work was supported by the Korea Health Technology R&D Project through the Korean Health Industry Development Institute (KHIDI), the Ministry of Health and Welfare, Republic of Korea (grant number: HI15C3153).
The authors declare no conflicts of interest.
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© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
