The prevalence of social frailty among older adults: A systematic review and meta-analysis

The association between social frailty, psychological resilience, and subsequent cognitive outcomes in older adults: A prospective cohort study

BACKGROUND

The associations among social frailty, psychological resilience, and cognitive function, as well as their variations across sex and age, remain to be explored. The objective of the present study was to investigate these complex relationships in older adults.

METHODS

This study included 5555 participants from the CLHLS and categorized them into socially robust (n = 2229; 40.12%), social pre-frailty (n = 2624; 47.24%), and social frailty (n = 702; 12.64%) groups. The relationship between social frailty and cognitive outcomes was analyzed using logistic regression models and restricted cubic splines. The combined effects of social frailty and psychological resilience on cognitive outcomes were also analyzed. The mediating role of psychological resilience was evaluated using the SPSS PROCESS macro program.

RESULTS

Social pre-frailty (odds ratio [OR]: 1.81, 95%CI: 1.48-2.21) and social frailty (OR: 2.40, 95%CI: 1.87-3.09) were positively associated with cognitive impairment. Furthermore, social pre-frailty (OR: 1.71, 95%CI: 1.47-2.00), and social frailty (OR: 2.10, 95%CI: 1.69-2.60) were also positively associated with greater cognitive decline. Adverse cognitive outcomes demonstrated a nonlinear relationship with social frailty. Compared to individuals with social robustness and high psychological resilience, those with social frailty and low psychological resilience demonstrated higher odds ratios of developing cognitive impairment (OR: 3.65, 95%CI: 2.61-5.10) and experiencing greater cognitive decline (OR: 3.05; 95%CI: 2.33-4.00). The relationship between social frailty and negative cognitive outcomes was more pronounced among women and individuals younger than 80 years and exhibited a nonlinear pattern. Psychological resilience mediated the relationship between social frailty and cognitive outcomes in men (β = -0.0091, P < 0.05) and individuals with advanced age (β = -0.0087, P < 0.05).

CONCLUSIONS

Social frailty is an independent influencing factor of adverse cognitive outcomes. Psychological resilience mediates the relationship between social frailty and cognitive function in men and subjects of advanced age.

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.

The prevalence and related factors of social frailty in older adults: A low- and middle-income country perspective

OBJECTIVES

There are no studies examining the prevalence of social frailty and associated factors in low- and middle-income countries. This study aimed to assess the prevalence of social frailty and identify the contributing factors among older adults in Türkiye.

METHODS

This cross-sectional study included 570 participants aged 65 and older, all outpatients at a geriatric clinic. Data for demographics and co-morbidities were collected. Anthropometric measurements and comprehensive geriatric assessments were conducted. Social frailty was assessed using the 5-item Social Frailty Index (SFI), and physical frailty was evaluated with the Fried Frailty Phenotype. Sarcopenia was diagnosed based on low handgrip strength and reduced calf circumference.

RESULTS

Participants' mean age was 75.2 ± 6.3 years. Social frailty, depression, physical frailty and sarcopenia prevalence were 24%, 25%, 14% and 26%, respectively. Social frailty was reported to be statistically higher in women and those living alone, while significantly lower in married individuals. Depression, physical frailty and sarcopenia were more commonly observed in participants with social frailty (p < .01). Furthermore, participants with heart failure and Parkinson's disease were more socially vulnerable than those with other co-morbid conditions. Multivariate logistic regression analysis revealed that age, physical frailty and depressive mood significantly increased social frailty, whereas being married decreased it even after adjusting for potential confounding factors.

CONCLUSIONS

Social frailty was more prevalent than physical frailty among Turkish older adults, reaching 24%. Advanced age, depression, physical frailty and being unmarried were strongly related factors to social frailty.

Multifaceted impacts of double-aging neighborhood's built environments on SAIP: a deep dive into Chinese rapidly aging urban society

Introduction

The healthy aging of older adults in dual-older adult communities is influenced by multiple factors, and understanding its underlying mechanisms can promote healthy aging among the older adults in a wide range of developing countries. This comprehensive study delves into the intricate interplay between multifaceted built environmental factors, and their direct and indirect effects on the successful AIP residing in double-aging neighborhoods.

Methods

Applying a series of HLM, the research meticulously explores the intricate links between SAIP and multi-scale aging spaces, including home space, community social participation, and built environments.

Results

The results show that: (1) Older adults people's need for spiritual comfort derived from home space exceed the need for financial support and family care, becoming a major positive factor for SAIP; (2) The neighborhood based on acquaintance society, partly replace the role of home-based care in influencing SAIP. Especially, community participation has a positive impact, serving as an extension of the home space, such as college for senior citizens and outdoor activity space; (3) The built environment of double-aging neighborhoods has a significant positive effect, with a sense of place identity replacing the reliance on family members and acquaintances to facilitate SAIP; (4) In high-density old district, the distribution of public facilities is saturated, and the proper utilizes of these facilities becomes an important factor affecting SAIP.

Discussion

We provide a multi-factorial perspective of SAIP, demonstrating the compensatory and substitutional roles of community-based older adults care services and friendly neighborhood relationships in fulfilling home-based older adults care functions. This approach better promotes the construction of age-friendly communities and supports SAIP.

Digital health interventions for non-older individuals at risk of frailty: A systematic review and meta-analysis

Objective

Frailty is a significant health problem that results in adverse outcomes, reduced quality of life, and increased medical and nursing care costs. This study aimed to review the effect of digital health interventions on improving physical activity, physical function, and social function in non-older individuals at risk of frailty.

Methods

Randomized controlled trials of digital health interventions reporting frailty-related outcomes on physical activity, physical function, and social function in non-older individuals at risk of frailty were collected. The literature was reviewed, and the risk of bias was assessed. Meta-analyses were conducted for each outcome, and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation.

Results

The review included a total of 63 records. The meta-analysis showed that digital health interventions positively affected the volume of physical activity, daily steps, walking test, walking speed, VO2peak, dynamic gait index, timed up and go test, and MOS 36-Item Short-Form Health Survey Social Functioning. However, no significant effect on the time of physical activity was found. Despite the absence of fatal bias, the overall certainty of the evidence was not high because of the small number of studies and participants included in the analysis.

Conclusions

Digital health interventions can improve physical activity, physical function, and social function in non-older individuals at risk of frailty. However, the evidence had limited certainty, and the evidence supporting the effect of digital health intervention is insufficient. Thus, more studies are needed to clarify the effects of these interventions.

The status quo and influencing factors of intrinsic capacity among community-dwelling older adults from the perspective of Ecological Systems Theory: A cross-sectional study

BACKGROUND

As intrinsic capacity (IC) declines, older adults are at a significantly increased risk of frailty, care dependency, and death. Currently, the research on IC among older adults in China was still insufficient. We aimed to identify the status quo and influencing factors among community-dwelling older adults in China and explore the relationship between IC, external environment, and social network.

METHODS

A convenience sampling method was used to collect 312 older people from May 2023 to February 2024 in five communities in Chengdu, Sichuan Province. Data were collected using the general information questionnaire, Integrated Care of the Elderly (ICOPE) screening tool, World Health Organization Quality of live scale (WHOQOL-100), and Social Network Scale (LSNS-6).

RESULTS

The IC score among Chinese community-dwelling older adults was 3.39 ± 1.60, and the prevalence of IC decline was 86.9%. Marital status, age, number of chronic diseases, social network, and external environment were influencing factors of IC, which explained 35.7% of the total variance. External environment and social network were positively correlated with IC.

CONCLUSIONS

Chinese community-dwelling older adults had low IC scores and a high prevalence of IC decline. The government should focus on IC for older adults, especially those who are older, not married or widowed, and suffering from multiple chronic diseases. In addition, the richer the external resources available to older adults, the more social support they received, and the better the IC. These findings could provide a theoretical basis for managing and improving IC in older adults.

The prevalence and factors of posttraumatic growth among nurses based on the PTGI: A systematic review and meta-analysis

BACKGROUND

The urgency and risk of clinical nursing may cause nurses to experience traumatic stress, but it may also lead to posttraumatic growth. However, no study has comprehensively analyzed the prevalence of posttraumatic growth among nurses using a unified outcome measure and a validated assessment tool.

AIM

This study aims to systematically assess the prevalence and factors of posttraumatic growth among nurses based on the Posttraumatic Growth Inventory (PTGI).

METHODS

Ten databases, including The Cochrane Library, PubMed, Web of Science, CINAHL, Springerlink, Embase, Chinese Biomedical (CBM), China National Knowledge Infrastructure (CNKI), WanFang, and VIP databases, were searched as of December 31, 2022. The prevalence of posttraumatic growth was pooled using Stata 17.0 software. The PRISMA guideline was used to report the systematic review and meta-analysis. PROSPERO registration number: CRD42022365620.

RESULTS

A total of 30 studies were included in this systematic review and meta-analysis, consisting of 14,022 nurses worldwide from four countries. In our study, the pooled mean score of posttraumatic growth among nurses was 66.34 (95% CI: 61.25-71.43). From 2015 to 2022, nurses' posttraumatic growth levels gradually increased. In addition, Turkey nurses have the lowest posttraumatic growth levelnurses who experienced workplace violence have a lower posttraumatic growth level compared with other nurses; while nurses aged over 30 and male have higher posttraumatic growth levels.

CONCLUSIONS

While several studies on the prevalence of posttraumatic growth among nurses have been published, the reported data are quite different. Our systematic review and meta-analysis found that nurses' posttraumatic growth level was "moderate," and nurses' posttraumatic growth may vary based on publication year, country, traumatic event, age, and gender.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Our findings may provide a theoretical basis for hospital administrators and policy makers to scientifically manage human resources, comprehensively evaluate nurses' mental health, and promote nurses' posttraumatic growth in different traumatic events, which is conducive to the formulation and implementation of relevant policy guidelines.

Prevalence of social frailty and risk factors among community-dwelling older adults: A systematic review and meta-analysis

BACKGROUND

Older people are more vulnerable to social frailty due to age, physical condition and socio-economic status. Since social frailty can lead to adverse health outcomes, it is essential to understand the current state of social frailty among community-dwelling older adults.

AIMS

To consolidate existing evidence for rates of social frailty and risk factors.

METHODS

Two researchers independently selected studies, extracted data, assessed the quality of the studies included in the literature, and calculated the rate of social frailty through a random-effects model with OR and 95 % CI for risk factors.

RESULTS

The literature search yielded a total of 81,414 articles, with 28 articles ultimately meeting the study criteria and being included in the meta-analysis. The prevalence of social frailty among community-dwelling older adults was 20.0 % (95 % CI 15.0 %-25.0 %, I2 = 99.5 %, P < 0.001). MSFI and other criteria yielded social frailty rates of 20.6 % and 18.3 %, respectively. The rate of social frailty was 20.2 % for the cross-sectional design and 19.3 % for the cohort design. The prevalence of social frailty is 20.2 % in Asian countries and 17.4 % in European countries. The rate of social frailty is 22.0 % for those aged 75 and over and 17.9 % for those under 75. Multiple chronic conditions, a major illness, marital status, sleep quality, and depressive symptoms are associated with social frailty.

CONCLUSION

Social frailty affects nearly one in five community-dwelling older adults, and having multiple chronic conditions, having a major illness, being single, poor sleep quality, and depression are all risk factors for social frailty.

Changes in frailty and lifestyle among community-dwelling older adults: A two-point cross-sectional study during and after the COVID-19 pandemic in Japan

We aimed to verify the characteristics of lifestyles and frailty among older adults during and after the COVID-19 pandemic. This two-point cross-sectional study conducted a baseline survey (BL) in 2020 and a follow-up survey (FU) in 2023 with community-dwelling individuals aged ≥65 years in Japan. The 700 and 572 participants in the BL and FU were analyzed. We compared frailty occurrence and lifestyle characteristics between both surveys. In the BL and FU, 38.3 %, 52.4 %, and 9.3 % and 29.4 %, 59.4 %, and 11.2 % of the individuals were classified as robust, pre-frail, and frail, respectively, showing a significant decrease in the number of robust, and an increase in the number of pre-frail. A significant decrease in dietary intake was observed among robust individuals in the FU, with an overall significant decrease in communication opportunities in the BL. Therefore, lifestyle changes due to infection control measures may have a delayed impact on frailty.

The relationship between social frailty and loneliness in community-dwelling older adults: a cross-sectional study

BACKGROUND

Social frailty (SF) is associated with multiple adverse health outcomes, yet there has been an inadequate focus on social frailty. The convoy model portrays the social networks through the perspective of the life course, thus providing a framework to explain the occurrence of social frailty. This study aimd to figure out the prevalence of social frailty and loneliness among community-dwelling older adults and to explore their correlations based on convoy model.

METHODS

This was a cross-sectional study, and 295 older adults from 10 communities of Zhengzhou in Henan Province participated in the study. Social frailty and loneliness were assessed separately with the Social Frailty Scale and University of California at Los Angeles-Loneliness Scale. The scores of social frailty of the older adults in different characteristic communities were compared by independent sample t-test and single factor analysis of variance. The influencing factors of social frailty were analysed by multiple stepwise linear regression and the structural equation model. The correlation between social frailty and loneliness was analysed by Pearson correlation analysis.

RESULTS

The total scores of social frailty and loneliness of the older adults in the community were (2.09 ± 1.53) and (43.19 ± 8.91), respectively. There was a moderate positive correlation between social frailty and loneliness (r = 0.621, P < 0.01). The results of multiple stepwise linear regression analysis showed that age, living styles, balance of payments, and loneliness were the main influencing factors of the social frailty of older adults in the community (F = 27.180, P < 0.001). The structural equation model of social frailty fitted well (χ2 = 47.292, df = 26, χ2/df = 1.819, P = 0.007; RMSEA = 0.053, 95%CI (0.028, 0.076), P = 0.359; GFI = 0.971; AGFI = 0.939; NFI = 0.904; IFI = 0.955; TLI = 0.918; CFI = 0.953; SRMR = 0.0466).

CONCLUSIONS

The convoy model had certain applicability in explanation of the relationship between loneliness and social frailty among older adults in community. The incidence of social frailty among the older adults in the community was high, and loneliness was at a medium level. It is necessary to strengthen the intervention of social frailty and loneliness of the older adults in the community, improve the quality of life of the older adults, and promote the development of healthy aging.

Understanding social frailty

Social frailty, along with physical and psychological frailties, is one of the components of frailty that has been reported to increase the incidence of adverse health outcomes. Although the prevalence of social frailty is relatively high, consensus on how to define and measure it is insufficient. In considering social frailty, living alone, interaction with neighbors, and social participation are important indicators, and interaction with neighbors and social participation, which are modifiable factors, are important countermeasures. The promotion of these social activities will contribute to extending healthy life expectancy-for example, by promoting physical activity. However, older people's physical and social activities have been severely constrained by the coronavirus pandemic since 2020. In the future, it will be necessary to fully understand the characteristics and significance of social frailty and develop appropriate countermeasures.