Social Frailty Is Independently Associated with Mood, Nutrition, Physical Performance, and Physical Activity: Insights from a Theory-Guided Approach

Abstract

Notwithstanding the increasing body of evidence that links social determinants to health outcomes, social frailty is arguably the least explored among the various dimensions of frailty. Using available items from previous studies to derive a social frailty scale as guided by the Bunt social frailty theoretical framework, we aimed to examine the association of social frailty, independently of physical frailty, with salient outcomes of mood, nutrition, physical performance, physical activity, and life–space mobility. We studied 229 community-dwelling older adults (mean age 67.22 years; 72.6% females) who were non-frail (defined by the FRAIL criteria). Using exploratory factor analysis, the resultant 8-item Social Frailty Scale (SFS-8) yielded a three-factor structure comprising social resources, social activities and financial resource, and social need fulfilment (score range: 0–8 points). Social non-frailty (SNF), social pre-frailty (SPF), and social frailty (SF) were defined based on optimal cutoffs, with corresponding prevalence of 63.8%, 28.8%, and 7.4%, respectively. In logistic regression adjusted for significant covariates and physical frailty (Modified Fried criteria), there is an association of SPF with poor physical performance and low physical activity (odds ratio, OR range: 3.10 to 6.22), and SF with depressive symptoms, malnutrition risk, poor physical performance, and low physical activity (OR range: 3.58 to 13.97) compared to SNF. There was no significant association of SPF or SF with life–space mobility. In summary, through a theory-guided approach, our study demonstrates the independent association of social frailty with a comprehensive range of intermediary health outcomes in more robust older adults. A holistic preventative approach to frailty should include upstream interventions that target social frailty to address social gradient and inequalities.

Nutrition Mediates the Relationship between Osteosarcopenia and Frailty: A Pathway Analysis

“…Thus, our findings further provide the impetus for nutritional assessment and early supplementation in osteosarcopenia to ameliorate the detrimental effects of frailty. However, in this cohort, the proportion of the total effect mediated by nutrition is small, suggesting that other mechanisms, such as physical activity or social factors [ 37 ], are also important to prevent the development of frailty.…”

The Simplified Nutritional Appetite Questionnaire (SNAQ) as a Screening Tool for Risk of Malnutrition: Optimal Cutoff, Factor Structure, and Validation in Healthy Community-Dwelling Older Adults

“…We also measured life-space mobility using the Life-Space Assessment (LSA), which comprises five space-levels corresponding to activities outside the bedroom, home, neighborhood, town, and beyond, respectively [33]. Using cohort quintile cutoffs, we defined low physical activity as FAI ≤29 and IPAQ <2826 METS respectively, and low life-space mobility as LSA <76 [34].…”

“…Social frailty was assessed via the locally-validated eight-item Social Frailty Scale (SFS-8), which measures the three domains of social resources, social activities and financial resources, and social need fulfilment (score range: 0-8 points). A score of 0-1 denotes social nonfrailty, 2-3 denotes social prefrailty, and a score of 4 and above denotes social frailty [34].…”

Association of Social Frailty with Physical Health, Cognitive Function, Psychological Health, and Life Satisfaction in Community-Dwelling Older Koreans

“…Frailty is defined as a biological syndrome of extreme vulnerability to endogenous and exogenous stressors associated with multisystem decline in physiological reserve, resulting in increased risk of adverse outcomes including disability, hospitalization, and death [ 3 , 9 ]. This multidimensional concept has physical, cognitive, psychological, and social components [ 10 ].…”