Frailty Combined with Loneliness or Social Isolation: An Elevated Risk for Mortality in Later Life

Journal of the American Geriatrics Society - Tập 68 Số 11 - Trang 2587-2593 - 2020
Emiel O. Hoogendijk1, Annelot P Smit1, Carmen van Dam2, Noah A. Schuster1, Sascha de Breij1, Tjalling J. Holwerda1, Martijn Huisman1,3, Elsa Dent4,5, Melissa K. Andrew6
1Department of Epidemiology & Biostatistics Amsterdam Public Health Research Institute, Amsterdam UMC – Location VU University Medical Center Amsterdam The Netherlands
2Department of Internal Medicine and Geriatrics Amsterdam UMC – Location VU University Medical Center Amsterdam The Netherlands
3Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
4Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
5Torrens University Australia, Adelaide, South Australia, Australia
6Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada

Tóm tắt

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.

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Journal of the American Geriatrics Society

Tập 68 Số 11

2587-2593

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