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  • Writer's pictureNancy Griffin

Social Frailty Linked to Poor Health Outcomes for Older Adults

Social frailty index by Mass General and UCSF measures vulnerability and offers insights into the complex needs of older adults.

In February, researchers at Massachusetts General Hospital and the University of California, San Francisco published a 10-item “social frailty index” in the Proceedings of the National Academy of Sciences journal. Using data from 8,250 adults 65 and older who participated in the national Health and Retirement Study from 2010 to 2016, the researchers found that the index helped predict an increased risk of death in a significant number of older adults, complementing medical tools used for this purpose.

What is Social Frailty?

Frailty is classified as weakness, weight loss, exhaustion, low physical activity, a slowed walking speed, and increases in the risk of falls, disability, hospitalization, poor surgical outcomes, admission to a nursing home and earlier death in older adults. Those who are socially frail don’t have close relationships, can’t rely on others for help, aren’t active in community groups or religious organizations, or live in neighborhoods that feel unsafe, among other circumstances. Also, social frailty can entail feeling a lack of control over one’s life or being devalued by others.

Social frailty assumes that each factor contributes to an older person’s vulnerability and that the factors interact and build upon each other. Many of these factors have been linked to poor health outcomes in later life, along with other social determinants of health such socioeconomic status, poor nutrition, insecure housing, and inaccessible transportation.

In 2022, Chinese researchers published a comprehensive review of social frailty in older adults. Based on an accumulation of responses from 83,900 participants in Japan, China, Korea and Europe, 24% of over the age of 60 were socially frail — a higher portion than those deemed physically frail (12%) or cognitively frail (9%) in separate studies. Most vulnerable were people 75 and older.

A More Comprehensive Approach

“It adds dimensions of what a clinician should know about their patients beyond current screening instruments, which are focused on physical health,” said Dr. Linda Fried, a frailty researcher and dean of the Mailman School of Public Health at Columbia University. “Beyond the corridors of medicine, we need society to build solutions to issues raised in the index — the ability of older adults to work, volunteer and engage with other people; the safety and accessibility of neighborhoods in which they live; ageism and discrimination against older adults; and more.”

“It’s a more complete picture of older adults’ circumstances than any one factor alone,” said Dr. Melissa Andrew, a professor of geriatric medicine at Dalhousie University in Halifax, Nova Scotia, who published an earlier social vulnerability index: Social Vulnerability, Frailty and Mortality in Elderly People. “If a series of individual deficits could be combined to estimate not just relative fitness/frailty, but also social vulnerability, the resulting social vulnerability index variable would offer insights into understanding the complex health and social care needs of older adults. Especially as people become very old, ‘social’ and ‘medical’ factors have a complex inter-play that affects important health outcomes and is important for both clinical care and policy-making.”

Quality Relationships Are Key

Quality relationships are the key to overcoming social frailty. University of Queensland research found women who have quality relationships in their 40s and 50s are less likely to develop multiple chronic conditions in older age. Lead author Dr Xiaolin Xu, from the UQ School of Public Health, found that having unsatisfying social relationships can be as much of a risk factor for disease as obesity, physical inactivity or alcohol intake.

New research in Social Psychological and Personality Science provides further evidence that the quality of your close relationships affects your health. Researchers found that, on average, people with more positive experiences and fewer negative experiences reported lower stress, better coping, and lower systolic blood pressure reactivity leading to better physiological functioning in daily life. By contrast, variability—or daily ups and downs—in negative relationship experiences like conflict were especially predictive of outcomes like stress, coping, and overall blood pressure.

Look for more senior living and home health providers to address social frailty by encouraging positive relationships—especially between generations. Senior living communities are in an ideal position to foster connections among resident, staff, family and the local community. Not only do healthier residents equals a healthier bottom line for senior living operators, opportunities for engagement and connection are key elements of aspirational senior living.


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