Effect modification of social participation in the relationship between living arrangements and frailty among older adults in Japan: Differences based on gender

Social isolation in relation to the incidence and dynamic progression of frailty in the oldest old: a trajectory analysis of a nationwide cohort

BACKGROUND

There is still a lack of evidence examining the association of behavioral and social factors with frailty transitions and mortality. We investigated whether social isolation is associated with different progressions and outcomes of frailty among community-dwelling older adults.

METHODS

This community-based cohort study assessed the frailty index and objective social isolation of 31,168 participants (58.3% female; average age: 88.1 ± 11.1 years) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2018. Four Markov state-transition models were constructed to examine the associations between social isolation and the seven transitions of the frailty trajectory.

RESULTS

According to the Markov state-transition model, for every one-point increase in the social isolation score of non-frail participants, the risk of developing prefrailty increased by 4.2% [hazard ratio (HR) = 1.042, 95% confidence interval (CI): 1.007-1.079], whereas for prefrail participants, the risk of developing frailty and death increased by 3.9% (HR = 1.039, 95% CI: 1.007-1.073) and 16.1% (HR = 1.161, 95% CI: 1.099-1.226), respectively. For each increase in the social isolation score in the frail population, the risk of death increased by 2.9% (HR = 1.029, 95% CI: 1.004-1.054). Socially isolated persons had a greater cumulative transition probability to prefrailty and frailty. Socially isolated women were more likely to experience prefrailty and frailty than socially isolated men, whereas the latter were more likely to die from prefrailty and frailty than the former.

CONCLUSIONS

This study indicates that social isolation may contribute to an increased risk of both the incidence and progression of frailty, elevating deterioration risks in initially non-frail and prefrail populations, while primarily exacerbating mortality risks in those already experiencing prefrailty or frailty.

Development and validation of the social frailty scale for the older adult in China

Objectives

Existing social frailty instruments are not tailored to the linguistic and cultural characteristics of Chinese-speaking patients; a version addressing this gap will increase clinical understanding of their healthcare experience and may help guide social frailty. To develop a Chinese version of a Social Frailty Scale (CVSFS) for the older adult and to examine the psychometric properties of this instrument.

Method

Based on the recommendations of the COSMIN guidelines, the scale development inclued three phases: development of the initial scale, optimisation of scale items, and validation test for scale. The initial CVSFS 1.0 version was developed through literature review, semi-structured interviews, research team discussion, and Delphi method. Then, cross-sectional survey was conducted (n = 265) and scale items were optimized based on the survey results using item analysis and exploratory factor analysis (EFA) to form CVSFS 2.0 version. Lastly, the cross-sectional survey (n = 287) was repeated using CVSFS 2.0 version, and the reliability and validity of the scale's measurement properties were tested.

Results

The initial scale stage of development formed a 42-item CVSFS 1.0 version. After item analysis and EFA, six items were excluded to form a four-dimension with 36-item CVSFS 2.0 version including individual level, family level, interpersonal level, community and social level. The CVSFS 2.0 version demonstrated good reliability and validity, with a Cronbach's α coefficient of 0.926 and a McDonald's ω estimate of 0.931, split-half reliability of 0.928, and test-retest reliability of 0.978. The I-CVI of the scale was calculated to be 0.889~1.000, and the S-CVI/Ave was 0.930. Confirmatory factor analysis results indicated satisfactory fit indices: χ2/df = 2.17, GFI = 0.813, TLI = 0.932, CFI = 0.937, RMSEA = 0.064.

Conclusions

The CVSFS 2.0 version developed in this study based on a social-ecological framework has high reliability and validity, making it a suitable instrument for evaluating social frailty among the older adult in China.

Can intelligent virtual assistants improve cognitive function in older adults? A two-wave mediation study

Objectives

This study aims to investigate whether social networks and physical exercise mediate the relationship between new and constant use of intelligent virtual assistants (IVAs) and cognitive function in older adults in China and explore the potential differences across living arrangements and education levels.

Methods

This study utilized nationally representative longitudinal data from 2018 to 2020, including a sample of 8343 older adults aged 60-80. A path-analytic model was employed to examine the relationship between IVAs use and cognitive function, as well as the mediating roles of social networks and physical exercise.

Results

Constant and new IVAs use significantly affected cognitive function, mediated by social networks and physical exercise. For older adults living alone, both types of IVAs use had positive direct and indirect effects. Those living with children benefited mainly from new IVAs use, with indirect effects through physical exercise. Among less educated older adults, only new IVAs use showed significant effects through social networks. For those with higher education, both constant and new IVAs use positively impacted cognitive function directly and indirectly.

Conclusions

The use of IVAs can significantly improve cognitive function in older adults, with social networks and physical exercise being important mediating pathways. Policy suggestions were provided based on these results.

Longitudinal relationship between social participation, depressive symptoms, and activity impairment among older patients with arthritis: a moderated mediation analysis

BACKGROUND

Arthritis primarily affects older people and is a prominent cause of their activity impairment. This study aimed to examine the mediating role of depressive symptoms in the relationship between social participation and activity impairment, as well as to determine whether sex moderated the mediating effect.

METHODS

A total of 2247 older patients with arthritis were included from the China Health and Retirement Longitudinal Study between 2015 and 2018. We first examined a simple mediation model where depressive symptoms were a mediator between social participation and activity impairment. Furthermore, sex was systematically integrated into the model as a moderator. The mediation model and moderated mediation model were analyzed using PROCESS macro.

RESULTS

Mediation analysis revealed that the association between social participation and activity impairment was partially mediated by depressive symptoms (B = -0.10, 95% CI = [-0.14, -0.06]) with intermediary effect of 28.6%. Moderated mediation analysis indicated that mediation model was moderated by sex. The indirect effect of social participation on activity impairment among female patients (B = -0.15, 95% CI = [-0.21, -0.09]) was stronger than male patients (B = -0.04, 95% CI = [-0.09, -0.01]).

CONCLUSION

Social participation was the key protective factor associated with depressive symptoms and activity impairment among arthritis patients. Encouraging arthritis patients to social participation and improving the depressive symptoms might avoid activity impairment, especially for female patients.