Social Frailty Predicts Incident Disability and Mortality Among Community-Dwelling Japanese Older Adults

Objective: To determine the prevalence of social frailty and its relation to incident disability and mortality in community-dwelling Japanese older adults. Design: Prospective cohort study. Setting and Participants: 6603 community-dwelling adults aged 65 years and older who were living independently in a city in Shiga prefecture in 2011. Outcomes: The outcomes were incident disability and mortality. We defined incident disability using new long-term care insurance (LTCI) service requirement certifications, and the follow-up period was 6 years after the mailed survey. Measurements: The 4-item social frailty screening questionnaire was developed and included general resources, social resources, social behavior, and fulfillment of basic social needs. We categorized the respondents into 3 groups based on the level of social frailty. Additionally, we assessed physical/psychological frailty by the frailty screening index and other demographic variables. Results: The prevalences of social frailty, social prefrailty, and social robust were 18.0%, 32.1%, and 50.0%, respectively. During the 6-year follow-up period, 28.1% of those with social robust, 36.9% of those with social prefrailty, and 48.5% of those with social frailty died or experienced incident disability. Those with social prefrailty [adjusted hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.16-1.41] and social frailty (adjusted HR 1.71, 95% CI 1.54-1.90) had significantly elevated risks for incident disability and mortality based on multivariate analyses that used social robust as the reference. Furthermore, the combination of social frailty and physical/psychological frailty is more likely to result in incident disability and mortality compared to social frailty or physical/psychological frailty alone. Conclusions/Implications: Community-dwelling older adults with both social frailty and physical/psychological frailty are at higher risk of death or disability over 6 years than are older adults with only one type of frailty or no frailty. Screening and preventive measures for social frailty are suggested for healthy aging. (c) 2018 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.