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.
Highlights
Frailty is characterized by a loss of physiological reserves, leading to increased vulnerability of the older adult with stressor events [1]
In the present study, using a theory-guided social frailty scale that is grounded in the Bunt conceptual framework, we build upon growing body of evidence about the paramount importance of social frailty by demonstrating the independent associations of social pre-frailty (SPF) and SF with mood, nutrition, physical performance, and physical activity in non-frail community-dwelling older adults
Even after adjusting for physical frailty, both SPF and SF were associated with poor physical performance and low physical activity, with SF associated with low mood and malnutrition
Summary
Frailty is characterized by a loss of physiological reserves, leading to increased vulnerability of the older adult with stressor events [1]. Frailty is widely regarded as a multidimensional construct with physical, cognitive, psychological, and social components. Among these dimensions, social frailty is arguably the least explored. Given the complex interplay between the dimensions of frailty and increasing appreciation of the contribution of social factors to health outcomes [2], it is not surprising that social frailty has been gaining recognition and traction in recent years. Res. Public Health 2020, 17, 4239; doi:10.3390/ijerph17124239 www.mdpi.com/journal/ijerph
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