Lonely older adults more likely to be frail

Feelings of loneliness seem to contribute to worse frailty among older adults, while social participation appears to have a protective effect, according to a recent Singapore study. Such interactions are independent of demographic indicators, such as age, sex, ethnicity, education, and lifestyle.

“This study observed that social isolation, social participation, and loneliness had differential longitudinal association with level of frailty among community-dwelling older adults in Singapore,” the researchers said. “Our findings suggest that loneliness and frailty should be measured and addressed concurrently among community-dwelling older adults.”

Drawing from the longitudinal Population Health Index Survey, the present study included 606 participants aged ≥60 years (57.6 percent women). Loneliness was quantified through the 6-item UCLA Loneliness Scale, Social isolation through the Lubben Social Network Scale-6 (LSNS-6), Social participation through the Late-Life Funtion and Disability Instrument, and level of frailty through the Clinical Frailty Scale.

At baseline, 19.6 percent of participants reported living alone. According to the “family” and “friends” subscale of the LSNS-6, 17.7 percent and 47.4 percent of participants were “isolated.” Meanwhile, 7.3 percent scored <6 on the loneliness scale, indicating that they could be categorized as “lonely.” [BMC Geriatr 2022;22:26]

Fixed-effects modelling showed that social participation was consistently and significantly associated with lower levels of frailty, yielding an odds ratio (OR) of 0.96 (95 percent confidence interval [CI], 0.93–0.99; p=0.019). The model was adjusted for all time-invariant and demographic factors, as well as lifestyle and health-related parameters such as smoking, chronic conditions, functional independence, nutrition, and medications.

Similarly, the dichotomous variable of loneliness (vs not feeling lonely) was also significantly associated with frailty, increasing its likelihood by almost threefold in the fully adjusted model (OR, 2.90, 95 percent CI, 1.44–5.84; p=0.003).

On the other hand, both the family (OR, 1.05, 95 percent CI, 0.97–1.14; p=0.231) and friends (OR, 0.99, 95 percent CI, 0.92–1.07; p=0.782) subscales of LSNS-6 were unrelated to frailty. These findings were robust to various sensitivity analyses.

“This was the first study to examine the association of both objective and subjective social connection with level of frailty among community-dwelling older adults using panel data from a longitudinal survey in Singapore,” the researchers said. “This study chose frailty as the dependent variable based on current local efforts in building a frailty-friendly community in Singapore.”

Though still incompletely elucidated, the mechanisms underlying the link among social isolation, social participation, loneliness, and frailty are likely to be complex, according to the researchers.

“While being isolated for a short period could be by choice and has less impact on health, loneliness, as a negative emotional feeling, may contribute to a series of physical and mental health issues including cardiovascular disease and stroke, increased stress and depression, and cognitive decline, thereby increasing the risk of development and progression of frailty,” they said. [Ageing Res Rev 2019;1:7-16; Pers Soc Psychol Bull 2019;45:240-253]

Meanwhile, social participation and a high degree of social interactions could help increase both an older adult’s physical and cognitive status, leading to a sense of belonging and lower risks of depression and frailty, the researchers noted.