Article Type : Short commentary
Authors : Bando H
Keywords : Social frailty (SF); Physical frailty (PF); Social Frailty Index (SFI); Tilburg Frailty; Indicator (TFI); Survey of health aging retirement in Europe (SHARE)
Current situation has brought many people less physical and social activities across the world. Consequently, there has been some concern about the exacerbation of frailty, especially in the elderly. The problems for the elderly have oral frailty (OF), social frailty (SF) and physical frailty (PF). PF subdomains are slow gait speed, weakness, exhaustion, low activity and weight loss. Social frailty criteria have 7 factors including living alone, no education, absence of confidence, infrequent contact, infrequent social activities, financial difficulty, and socioeconomic deprivation. As useful index for social frailty, Social Frailty Index (SFI) and Tilburg Frailty Indicator (TFI) will be recommended.
Currently, the pandemic of COVID-19 has spread
worldwide and become a crucial problem. In particular, activities are
restricted as lockdown. Among them, there is concern about the exacerbation of
frailty, especially in the elderly [1]. It is reported that the elderly was
exacerbated of frailty in 6 months. This article describes recent topics of
social and physical frailty. As to the recent report of social frailty, the
protocol was prospective cohort study, in which survey forms were sent to 1953
elderly people [2]. Among them, 593 forms returned without missing description
were analyzed (78.8 years in mean age, 77.4% females). The survey was conducted
twice 6 months apart. As a result, prevalence of pre-frail/frail was 55.0%/7.9%
and 57.3%/11.8% around June/December 2020, respectively. Consequently, frailty
transition ratio was calculated as 9.9%, from robust/pre-frail to frail level.
Thus, frailty increase may be related to COVID-19.
For elderly people, the changes in physical activity
(PA) were compared during January and April 2020. The participants (n=1600)
were 74.0 years in average with female 50%, and frailty 24.3% [3].
Consequently, total PA showed a significant decrease from 245 to 180 minutes in
median. It suggested higher disability development in future. A meaningful
study was reported to clarify mutual relationships among PA, oral frailty (OF)
and social frailty (SF) [4]. Subjects were 682 community-dwelling elderly
people aged ? 65 years. By logistic regression analysis, significant
associations were found between OF and decline in SF, PF and nutritional state.
For path analysis, direct relationship was observed in SF and OF, and OF/SF and
PF. Consequently, SF decline may directly bring decline in OF and PF. A recent
study was found whether PF predicts SF [5]. Cases included 342 socially robust
elderly following 4 social domains, including living alone, financial
difficulties, social activity and contact with neighbors. Analyses with these
domains did not show significant difference of risk factors. However, SF was
significantly increased using two social subdomains (adjusted Relative Ratio,
aRR: 1.78). They are slow gait speed (aRR: 3.41) and weakness (aRR: 1.06). For
physical frailty, five factors were assessed according to Fried phenotype [6].
They are slow gait speed, weakness, exhaustion, low activity and weight loss.
Similarly, the association between PF subdomains and OF was demonstrated for
380 elderly aged >65 [7]. In primary analysis, PF risk showed association
with OF (OR: 2.40). In secondary analysis, gait speed had association with OF
(OR: 0.85).
Regarding SF, it does not have generally accepted
definition. However, it is often evaluated as at least two items as no contact
with family, rarely visiting friends and going out infrequently [8]. Some
studies are known for adequate evaluation criteria. The Questionnaire of social
frailty shows the following 5 inquiries [9]. They are i) going out less
frequently compared with last year, ii) sometimes visiting your friends, iii)
feeling you are helpful to friends and family, iv) living alone, v) talking
with someone every day. SF criteria include the following 7 factors, including
living alone, no education, and absence of confidence, infrequent contact,
infrequent social activities, financial difficulty, and socioeconomic
deprivation [10]. SF phenotype shows the following 7 factors, which are living
alone, contact with family and/or friends and/or neighbors less than once a
week, lack of a person to help with ADL, infrequent contact (self-reported
variable), absence of a confidant, lack of support for daily living during the
past 3 months [11]. SF has been rather unexplored concept. For scoping review,
42 papers related to SF were analyzed from scientific databases [12]. The
results showed that SF may be defined as a continuation of risks of losing some
resources which are crucial for fulfilling fundamental social requirements
during the life span. Concepts of frailty have various aspects, then there have
been different methods which cover distinct dimensions. Regarding the research
on SF, 27 assessment tools were investigated [13]. Among them, most common
components from various frailty instruments included 5 factors. They are social
activities, social support, social network, loneliness and living alone.
There is a latest report of the Survey of Health Aging
Retirement in Europe (SHARE). It investigated the contribution of the changes
from social isolation to frailty in 27,468 cases aged >60 years [14]. The
ratio of baseline and two years later are as follows: i) robust: ii) pre-frail:
iii) frailty are 47.6%: 41.6%: 10.8% at baseline. After 2 years, i) robust
group showed still robust 61.8%, pre-frail 30.8%, frailty 2.6%. Similarly, ii)
pre-frail group showed progressed to frail 13.2%, and becoming robust 31.1%.
Among iii) frail group, 6.1% recovered to robust and 42.8% improved to
pre-frail. In order to study the prevalence of SF, 6603 elderly adults >65
years were followed up for 6 years [15]. As to SF, 4 factors were investigated
including social behavior, social resources, general resources and basic social
needs. The results of the prevalence showed social robust 50.0%, social
prefrailty 32.1% and social frailty 18.0%, respectively. For significant
elevation of risks for incident disability and mortality, hazard ratio was 1.28
and 1.71 for social pre-frailty and frailty group, respectively.
To investigate age-specific prevalence of frailty in
Japan for 6 years, meta-analyses data were analyzed for Integrated Longitudinal
Studies on Aging in Japan (ILSA-J) [16]. It included 7 studies (n=10312), 8
studies (n=7010), and others. As a result, overall prevalence of PF was
decreased from 7.0% (2012) to 5.3% (2017). Especially, frailty ratio aged
>70 years was decreased. As to frailty subitems, slight decreased were
observed including slowness, low activity, exhaustion and weight loss. From
mentioned above, there is a recommended index. It is Social Frailty Index (SFI)
based on the scoping reviews from the reports of Bunt, Teo, Yamada and others
[10-15]. Tilburg Frailty Indicator (TFI) [17,18] and Makizato index [19] would
be also useful for clinical practice. Furthermore, adequate 11 subdomains of SF
would be effective for future management [20]. They include financial
difficulties, living alone, absence of life supporters, giving and receiving
social support, opportunities to talk with someone, meeting friends, contact
with family and neighbours, frequency of going out, social interaction, social
activities, and contact with society. Finally, this article will be hopefully
useful for actual management in the future.
3. Yamada M, Kimura Y, Ishiyama D, Otobe Y,
Suzuki M, Koyama S, et al. Effect of the COVID-19 epidemic on physical activity
in community-dwelling older adults in Japan: A Cross-Sectional Online Survey. J
Nutr Health Aging. 2020; 948-950.
8. Arai H, Kozaki K, Kuzuya M, Matsui Y,
Satake S. Frailty concepts. Geriatr Gerontol Int. 2020; 14-19.
20.
Abe
N, Ide K, Watanabe R, Tsuji D, Saito M, Kondo K. Literature review and
verification of content validity of social frailty indicators. Jap J Geriatr.
2021; 24-35.