Social frailty and cognitive impairment in elderly people

The article examines the relationship between social fragility and cognitive impairment (CI) in elderly in the context of population ageing and the increasing proportion of age-related diseases. Social fragility is defined as a progressive loss of social resources, including support and social engagement, which is associated with an increased risk of depression, cognitive decline and dementia.

A comprehensive review of studies published between 2017, and November 2024 was conducted to examine social fragility and its association with CI. The paper provides an overview of current approaches to assessing social fragility, including the use of indices and scales. The main risk factors, including depression, physical activity and CI, and the mechanisms underlying this relationship are analyzed in detail.

Particular attention is paid to the consequences of social fragility for cognitive health and possible prevention strategies. The article discusses the role of social isolation, loneliness, reduced physical activity and diminished social interactions as key aspects that increase the risk of cognitive decline. It also points out that maintaining an active social network and participating in social life can slow the progression of CI and improve the quality of life of elderly.

Our work emphasizes the need for an interdisciplinary approach to the diagnosis and treatment of social fragility, which includes the development of social relationships, the promotion of physical activity and the participation in group activities. These measures can help to strengthen cognitive reserves, reduce the negative effects of social fragility and ensure an active, long life for the elderly population.

1. Zarocostas J. The UN reports global asymmetries in population growth. Lancet. 2022;400(10347):148. doi: 10.1016/S0140-6736(22)01323-X

2. Petersen RC, Yaffe K. Issues and Questions Surrounding Screening for Cognitive Impairment in Older Patients. JAMA. 2020 Feb 25;323(8):722-4. doi: 10.1001/jama.2019.22527

3. Kojima G. Frailty as a Predictor of Future Falls Among Community-Dwelling Older People: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc. 2015 Dec;16(12):1027-33. doi: 10.1016/j.jamda.2015.06.018. Epub 2015 Aug 5.

4. Ye L, Bally E, Korenhof SA, et al. The association between loneliness and frailty among community-dwelling older adults in five European countries: a longitudinal study. Age Ageing. 2024 Oct 1;53(10):afae210. doi: 10.1093/ageing/afae210

5. Hoogendijk EO, Afilalo J, Ensrud KE, et al. Frailty: implications for clinical practice and public health. Lancet. 2019 Oct 12;394(10206):1365-75. doi: 10.1016/S0140-6736(19)31786-6

6. Ye L, Elstgeest LEM, Zhang X, et al. Factors associated with physical, psychological and social frailty among community-dwelling older persons in Europe: a cross-sectional study of Urban Health Centres Europe (UHCE). BMC Geriatr. 2021 Jul 12;21(1):422. doi: 10.1186/s12877-021-02364-x

7. Fried LP, Ferrucci L, Darer J, et al. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004 Mar;59(3):255-63. doi: 10.1093/gerona/59.3.m255

8. De Vries NM, Staal JB, van Ravensberg CD, et al. Outcome instruments to measure frailty: a systematic review. Ageing Res Rev. 2011 Jan;10(1):104-14. doi: 10.1016/j.arr.2010.09.001. Epub 2010 Sep 17.

9. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005 Aug 30;173(5):489-95. doi: 10.1503/cmaj.050051

10. Andrew MK. Frailty and Social Vulnerability. Interdiscip Top Gerontol Geriatr. 2015;41:186-95. doi: 10.1159/000381236. Epub 2015 Jul 17.

11. Yamada M, Arai H. Understanding social frailty. Arch Gerontol Geriatr. 2023 Dec;115:105123. doi: 10.1016/j.archger.2023.105123. Epub 2023 Jul 9.

12. Li J, Zhu L, Yang Y, et al. Prevalence and potential influencing factors for social frailty among community-dwelling older adults: a systematic review and meta-analysis. BMC Geriatr. 2024 Sep 16;24(1):762. doi: 10.1186/s12877-024-05365-8

13. Bunt S, Steverink N, Olthof J, et al. Social frailty in older adults: a scoping review. Eur J Ageing. 2017 Jan 31;14(3):323-34. doi: 10.1007/s10433-017-0414-7

14. Zhang H, Hu Z, Jiang S, et al. Social frailty and the incidence of motoric cognitive risk syndrome in older adults. Alzheimers Dement. 2024 Apr;20(4):2329-39. doi: 10.1002/alz.13696. Epub 2024 Jan 29.

15. Teo N, Gao Q, Nyunt MSZ, et al. Social Frailty and Functional Disability: Findings From the Singapore Longitudinal Ageing Studies. J Am Med Dir Assoc. 2017;18(7):637.e13-637.e19. doi: 10.1016/j.jamda.2017.04.015

16. Hamid TA, Salih SA, Zillah Abdullah SF, et al. Characterization of social frailty domains and related adverse health outcomes in the Asia-Pacific: a systematic literature review. PeerJ. 2024 Mar 15;12:e17058. doi: 10.7717/peerj.17058

17. Abe T, Kitamura A, Seino S, et al. Differences in the Prevalence of and Factors Associated with Frailty in Five Japanese Residential Areas. Int J Environ Res Public Health. 2019 Oct 18;16(20):3974. doi: 10.3390/ijerph16203974

18. Bessa B, Ribeiro O, Coelho T. Assessing the social dimension of frailty in old age: A systematic review. Arch Gerontol Geriatr. 2018 Sep-Oct;78:101-13. doi: 10.1016/j.archger.2018.06.005. Epub 2018 Jun 18.

19. Yang L, Xue B, Zheng X, et al. The independent and combined effects of physical activity and depressive symptoms on frailty in community-dwelling older adults: A cross-sectional study. J Clin Nurs. 2024 Jul 10. doi: 10.1111/jocn.17331. Epub ahead of print.

20. Qi X, Li J. The Relationship between Social Frailty and Depressive Symptoms in the Elderly: A Scoping Review. Int J Environ Res Public Health. 2022 Dec 12;19(24):16683. doi: 10.3390/ijerph192416683

21. Toros T, Ogras EB, Toy AB, et al. The Impact of Regular Exercise on Life Satisfaction, Self-Esteem, and Self-Efficacy in Older Adults. Behav Sci (Basel). 2023 Aug 28;13(9):714. doi: 10.3390/bs13090714

22. Alonso-Recio L, Carvajal F, Merino C, Serrano JM. Social Cognition and Cognitive Decline in Patients with Parkinson's Disease. J Int Neuropsychol Soc. 2021 Aug;27(7):744-55. doi: 10.1017/S1355617720001204. Epub 2020 Nov 27.

23. Maltese G, Corsonello A, Di Rosa M, et al. Frailty and COVID-19: A Systematic Scoping Review. J Clin Med. 2020 Jul 4;9(7):2106. doi: 10.3390/jcm9072106

24. Montayre J, Kuo K, Leung KMC, Zhao I. Measuring Social Frailty: A Scoping Review of Available Scales and Tools. Gerontologist. 2024 Oct 1;64(10):gnae114. doi: 10.1093/geront/gnae114

25. Shah SJ, Oreper S, Jeon SY, et al. Social Frailty Index: Development and validation of an index of social attributes predictive of mortality in older adults. Proc Natl Acad Sci U S A. 2023 Feb 14;120(7):e2209414120. doi: 10.1073/pnas.2209414120. Epub 2023 Feb 7.

26. Gobbens RJ, Boersma P, Uchmanowicz I, Santiago LM. The Tilburg Frailty Indicator (TFI): New Evidence for Its Validity. Clin Interv Aging. 2020 Feb 21;15:265-74. doi: 10.2147/CIA.S243233

27. Freese KE, Vega A, Lawrence JJ, Documet PI. Social Vulnerability Is Associated with Risk of COVID-19 Related Mortality in U.S. Counties with Confirmed Cases. J Health Care Poor Underserved. 2021;32(1):245-57. doi: 10.1353/hpu.2021.0022

28. Lozupone M, La Montagna M, Di Gioia I, et al. Social Frailty in the COVID-19 Pandemic Era. Front Psychiatry. 2020 Nov 3;11:577113. doi: 10.3389/fpsyt.2020.577113

29. Zhang XM, Cao S, Gao M, et al. The Prevalence of Social Frailty Among Older Adults: A Systematic Review and MetaAnalysis. J Am Med Dir Assoc. 2023 Jan;24(1):29-37.e9. doi: 10.1016/j.jamda.2022.10.007. Epub 2022 Nov 17.

30. Choi K, Ko Y. The relationship between social frailty and cognitive impairment among older adults: the role of various types of internet use. Front Public Health. 2024 Sep 6;12:1424465. doi: 10.3389/fpubh.2024.1424465

31. Harrison SL, Sajjad A, Bramer WM, et al. Exploring strategies to operationalize cognitive reserve: A systematic review of reviews. J Clin Exp Neuropsychol. 2015;37(3):253-64. doi: 10.1080/13803395.2014.1002759. Epub 2015 Mar 9.

32. Kamin ST, Lang FR. Internet Use and Cognitive Functioning in Late Adulthood: Longitudinal Findings from the Survey of Health, Ageing and Retirement in Europe (SHARE). J Gerontol B Psychol Sci Soc Sci. 2020 Feb 14;75(3):534-9. doi: 10.1093/geronb/gby123

33. Shimoda T, Tomida K, Nakajima C, et al. Prevalence and Prognostic Impact of Multiple Frailty Domain in Japanese Older Adults. J Am Med Dir Assoc. 2024 Nov;25(11):105238. doi: 10.1016/j.jamda.2024.105238. Epub 2024 Sep 3.

34. Dong Q, Bu X, Wang T, et al. Profiles of physical frailty, social frailty, and cognitive impairment among older adults in rural areas of China: a latent profile analysis. Front Public Health. 2024 Jul 18;12:1424791. doi: 10.3389/fpubh.2024.1424791

35. Lee JJ, Park MK, Kim N, et al. Longitudinal Relationship Between Baseline Social Frailty and Cognitive Impairment in Older Adults: 14-Year Follow-Up Results From the Korean Longitudinal Study of Ageing. J Am Med Dir Assoc. 2024 Sep;25(9):105124. doi: 10.1016/j.jamda.2024.105124. Epub 2024 Jul 2.

36. Cui M, Jiao D, Miura KW, et al. Social Frailty and Functional Status in Japanese Older Adults: The Mediating Role of Subjective Cognitive Function. J Am Med Dir Assoc. 2024 Jul;25(7):104971. doi: 10.1016/j.jamda.2024.02.009. Epub 2024 Mar 24.

37. Scafato E, Solfrizzi V, Custodero C, et al; IPREA Working Group. Associations of a biopsychosocial frailty phenotype with all-cause dementia, Alzheimer's disease, vascular dementia, and other dementias: the Italian PRoject on the Epidemiology of Alzheimer's disease (IPREA). Geroscience. 2023 Jun;45(3):2037-49. doi: 10.1007/s11357-023-00781-x. Epub 2023 Apr 4.

38. Ong M, Pek K, Tan CN, et al. Social Frailty and Executive Function: Association with Geriatric Syndromes, Life Space and Quality of Life in Healthy Community-Dwelling Older Adults. J Frailty Aging. 2022;11(2):206-13. doi: 10.14283/jfa.2021.43

39. Matsue Y, Kamiya K, Saito H, et al. Prevalence and prognostic impact of the coexistence of multiple frailty domains in elderly patients with heart failure: the FRAGILE-HF cohort study. Eur J Heart Fail. 2020 Nov;22(11):2112-9. doi: 10.1002/ejhf.1926. Epub 2020 Jul 14.

40. Ma L, Sun F, Tang Z. Social Frailty Is Associated with Physical Functioning, Cognition, and Depression, and Predicts Mortality. J Nutr Health Aging. 2018;22(8):989- 95. doi: 10.1007/s12603-018-1054-0

41. Tsutsumimoto K, Doi T, Nakakubo S, et al. Impact of Social Frailty on Alzheimer's Disease Onset: A 53-Month Longitudinal Cohort Study. J Alzheimers Dis. 2019;70(2):587-95. doi: 10.3233/JAD-181178

42. Tsutsumimoto K, Doi T, Makizako H, et al. Association of Social Frailty With Both Cognitive and Physical Deficits Among Older People. J Am Med Dir Assoc. 2017 Jul 1;18(7):603-7. doi: 10.1016/j.jamda.2017.02.004. Epub 2017 Apr 11.

43. Adachi T, Tsunekawa Y, Tanimura D. Association among mild cognitive impairment, social frailty, and clinical events in elderly patients with cardiovascular disease. Heart Lung. 2022 Sep-Oct;55:82-8. doi: 10.1016/j.hrtlng.2022.04.011. Epub 2022 Apr 29.

44. Maruta M, Makizako H, Ikeda Y, et al. Characteristics of meaningful activities in community-dwelling Japanese older adults with pre-frailty and frailty. Arch Gerontol Geriatr. 2022 Mar-Apr;99:104616. doi: 10.1016/j.archger.2021.104616. Epub 2021 Dec 28.

45. Ko H, Jung S. Association of Social Frailty with Physical Health, Cognitive Function, Psychological Health, and Life Satisfaction in Community-Dwelling Older Koreans. Int J Environ Res Public Health. 2021 Jan 19;18(2):818. doi: 10.3390/ijerph18020818

46. Hayashi C, Tanaka H, Ogata S. Assessing timewise changes over 15 months in life-space mobility among community-dwelling elderly persons. BMC Geriatr. 2020 Nov 25;20(1):502. doi: 10.1186/s12877-020-01882-4

47. Solfrizzi V, Scafato E, Lozupone M, et al; Italian Longitudinal Study on Aging Working Group. Biopsychosocial frailty and the risk of incident dementia: The Italian longitudinal study on aging. Alzheimers Dement. 2019 Aug;15(8):1019-28. doi: 10.1016/j.jalz.2019.04.013. Epub 2019 Jul 2.

48. Bae S, Lee S, Lee S, et al. The role of social frailty in explaining the association between hearing problems and mild cognitive impairment in older adults. Arch Gerontol Geriatr. 2018 Sep-Oct;78:45-50. doi: 10.1016/j.archger.2018.05.025. Epub 2018 Jun 1.

49. Tsutsumimoto K, Doi T, Makizako H, et al. Social Frailty Has a Stronger Impact on the Onset of Depressive Symptoms than Physical Frailty or Cognitive Impairment: A 4-Year Follow-up Longitudinal Cohort Study. J Am Med Dir Assoc. 2018;19(6):504-10. doi: 10.1016/j.jamda.2018.02.008

50. Sugie M, Harada K, Nara M, et al. Prevalence, overlap, and interrelationships of physical, cognitive, psychological, and social frailty among community-dwelling older people in Japan. Arch Gerontol Geriatr. 2022 MayJun;100:104659. doi: 10.1016/j.archger.2022.104659. Epub 2022 Feb 12.

51. Guo CY, Sun Z, Tan CC, et al. MultiConcept Frailty Predicts the Late-Life Occurrence of Cognitive Decline or Dementia: An Updated Systematic Review and MetaAnalysis of Longitudinal Studies. Front Aging Neurosci. 2022 May 11;14:855553. doi: 10.3389/fnagi.2022.855553

52. Soysal P, Stubbs B, Lucato P, et al. Inflammation and frailty in the elderly: A systematic review and meta-analysis. Ageing Res Rev. 2016 Nov;31:1-8. doi: 10.1016/j.arr.2016.08.006. Epub 2016 Aug 31. Erratum in: Ageing Res Rev. 2017 May;35:364-5. doi: 10.1016/j.arr.2016.12.007

53. Cudjoe TKM, Selvakumar S, Chung SE, et al. Getting under the skin: Social isolation and biological markers in the National Health and Aging Trends Study. J Am Geriatr Soc. 2022;70(2):408-14. doi: 10.1111/jgs.17518. Epub 2021 Oct 26.

54. Ahmadian AJ, Lin JE, Neylan TC, et al. Social integration and inflammation in individuals with and without posttraumatic stress disorder. Brain Behav Immun. 2020 Oct;89:168- 74. doi: 10.1016/j.bbi.2020.06.013. Epub 2020 Jun 11.

55. Matthews T, Rasmussen LJH, Ambler A, et al. Social isolation, loneliness, and inflammation: A multi-cohort investigation in early and mid-adulthood. Brain Behav Immun. 2024;115:727-36. doi: 10.1016/j.bbi.2023.11.022. Epub 2023 Nov 21.

56. Groeger JL, Ayers E, Barzilai N, et al. Inflammatory biomarkers and motoric cognitive risk syndrome: Multicohort survey. Cereb Circ Cogn Behav. 2022;3:100151. doi: 10.1016/j.cccb.2022.100151

57. Nidadavolu LS, Feger D, Chen D, et al. Associations between circulating cell-free mitochondrial DNA, inflammatory markers, and cognitive and physical outcomes in community dwelling older adults. Immun Ageing. 2023 May 23;20(1):24. doi: 10.1186/s12979-023-00342-y

58. Zhou Z, Wang P, Fang Y. Loneliness and the risk of dementia among older Chinese adults: gender differences. Aging Ment Health. 2018 Apr;22(4):519-25. doi: 10.1080/13607863.2016.1277976. Epub 2017 Jan 17.

59. Saari ME, Giosa JL, Holyoke P, et al. Profiling the medical, functional, cognitive, and psychosocial care needs of adults assessed for home care in Ontario, Canada: The case for long-term 'life care' at home. PLoS One. 2024 Apr 1;19(4):e0300521. doi: 10.1371/journal.pone.0300521.