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Social isolation and loneliness as risk factors for the progression of frailty: the English Longitudinal Study of Ageing.

ABSTRACT: Background:loneliness and social isolation have been associated with mortality and with functional decline in older people. We investigated whether loneliness or social isolation are associated with progression of frailty. Methods:participants were 2,817 people aged ?60 from the English Longitudinal Study of Ageing. Loneliness was assessed at Wave 2 using the Revised UCLA scale (short version). A social isolation score at Wave 2 was derived from data on living alone, frequency of contact with friends, family and children, and participation in social organisations. Frailty was assessed by the Fried phenotype of physical frailty at Waves 2 and 4, and by a frailty index at Waves 2-5. Results:high levels of loneliness were associated with an increased risk of becoming physically frail or pre-frail around 4 years later: relative risk ratios (95% CI), adjusted for age, sex, level of frailty and other potential confounding factors at baseline were 1.74 (1.29, 2.34) for pre-frailty, and 1.85 (1.14, 2.99) for frailty. High levels of loneliness were not associated with change in the frailty index-a broadly based measure of general condition-over a mean period of 6 years. In the sample as a whole, there was no association between social isolation and risk of becoming physically frail or pre-frail, but high social isolation was associated with increased risk of becoming physically frail in men. Social isolation was not associated with change in the frailty index. Conclusion:older people who experience high levels of loneliness are at increased risk of becoming physically frail.

SUBMITTER: Gale CR

PROVIDER: S-EPMC5920346 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Social isolation and loneliness as risk factors for the progression of frailty: the English Longitudinal Study of Ageing.

Gale Catharine R CR Westbury Leo L Cooper Cyrus C

Age and ageing 20180501 3

<h4>Background</h4>loneliness and social isolation have been associated with mortality and with functional decline in older people. We investigated whether loneliness or social isolation are associated with progression of frailty.<h4>Methods</h4>participants were 2,817 people aged ≥60 from the English Longitudinal Study of Ageing. Loneliness was assessed at Wave 2 using the Revised UCLA scale (short version). A social isolation score at Wave 2 was derived from data on living alone, frequency of ...[more]

PMID: 29309502

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Project description:Background/objectivesFrailty, loneliness, and social isolation are all associated with adverse outcomes in older adults, but little is known about their combined impact on mortality.DesignProspective cohort study.SettingThe Longitudinal Aging Study Amsterdam.ParticipantsCommunity-dwelling older adults aged 65 and older (n = 1,427).MeasurementsFrailty was measured with the frailty phenotype (Fried criteria). Loneliness was assessed with the De Jong Gierveld Loneliness Scale. Social isolation was operationalized using information on partner status, social support, and network size. Two categorical variables were created, for each possible combination regarding frailty and loneliness (FL) and frailty and social isolation (FS), respectively. Mortality was monitored over a period of 22 years (1995-2017). Survival curves and Cox proportional hazard models were used to study the effects of the FL and FS combinations on mortality. Analyses were adjusted for sociodemographic factors, depression, chronic diseases, and smoking.ResultsFrailty prevalence was 13%, and 5.9% of the sample were frail and lonely, and 6.2% frail and socially isolated. In fully adjusted models, older adults who were only frail had a higher risk of mortality compared with people without any of the conditions (hazard ratio [HR] range = 1.40-1.48; P < .01). However, the highest risk of mortality was observed in people with a combined presence of frailty and loneliness or social isolation (HRFL = 1.83; 95% confidence interval [CI] = 1.42-2.37; HRFS = 1.77; 95% CI = 1.36-2.30). Sensitivity analyses using a frailty index based on the deficit accumulation approach instead of the frailty phenotype showed similar results, confirming the robustness of our findings.ConclusionFrail older adults are at increased risk of mortality, but this risk is even higher for those who are also lonely or socially isolated. To optimize well-being and health outcomes in physically frail older adults, targeted interventions focusing on both subjective and objective social vulnerability are needed.

Dataset Information

Social isolation and loneliness as risk factors for the progression of frailty: the English Longitudinal Study of Ageing.

Publications

Social isolation and loneliness as risk factors for the progression of frailty: the English Longitudinal Study of Ageing.

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