Imagine three hypothetical women in their mid 70s living in the same economic situation as each other with the same number of illnesses: diabetes, arthritis, and high blood pressure.
Ms. Green is usually at home and can go a week without speaking to anyone. She is in constant contact by phone with her family and friends, and she attends a virtual class with a group of students at a nearby college.
Ms. Smith stays at home, but she rarely speaks to people. Ms. Smith has lost contact with her friends and stopped attending church. She now spends her time watching TV.
Ms. Johnson is surrounded by friends and has a full schedule. Ms. Johnson walks with neighbors, volunteers at the local school twice weekly, attends church, and keeps in touch with her children who live far away.
There are three types of social situations, and three levels of risk for women who experience a fall or severe deterioration of health.
Experts suggest that Ms. Johnson is the most likely of the women to be taken to the doctor or to the hospital. Ms. Green may be checked by several people to arrange for assistance as she recovers.
Ms. Smith is unlikely to receive much assistance and would likely fare worse than others if her health was compromised. Experts would describe her as'socially vulnerable', or'socially fragile'.
Social frailty can be seen as a corollary of physical frailty. It is a group of vulnerabilities that includes weakness, exhaustion and slowness. These vulnerabilities have been shown to increase the likelihood of falls, disability and hospitalization. Poor surgical outcomes and admission to a nursing facility are all factors that contribute to an older person's earlier death.
People who are physically weaker have lower physiological strength and less biological capacity to recover from injury or illness.
Older adults are more vulnerable because of their social frailty
Socially frail people have less resources than others, but they have different reasons. They don't have close friends, can't rely upon others for help, don't participate in community groups or religious organisations, and live in unsafe neighborhoods. Social frailty can also lead to feeling devalued or unable to control one's own life.
These factors are all linked to poor health outcomes later in life.
Social frailty presumes that each factor contributes towards an older person's vulnerability, and that they interact with each other and build on each other.
Melissa Andrew, a professor in geriatric medicine at Dalhousie University, Halifax, Nova Scotia, published the first social vulnerability index for older adults in 2008.
Experts in the United States and around the world are paying more attention to this way of thinking about older adults and their social lives and how they impact health outcomes. Researchers from Massachusetts General Hospital and University of California, San Francisco published a 10-item "social frailty index" in Proceedings of the National Academy of Sciences journal in February.
The index was used to predict death in an increasing number of seniors 65 and over who took part in the national Health and retirement study from 2010 through 2016. This data was derived from 8250 participants.
"Our goal is for clinicians to identify older patients who have socially compromised status and to prompt problem-solving to help them deal with different challenges," said Dr. Sachin Shah (coauthor and researcher at Massachusetts General Hospital).
Dr. Linda Fried, a Frailty researcher at Columbia University and dean of Mailman School of Public Health, said, "It adds dimensions of how a clinician should learn about their patients beyond what current screening instruments are focused on physical illness."
Fried stated that society is needed to find solutions to the issues in the index. This includes older adults' ability to volunteer, work and interact with others, as well as the safety and accessibility to their neighborhoods. There are also concerns about discrimination and ageism against older adults.
Screening for additional help is easier with the social frailty index
A team of Chinese researchers published a comprehensive review on social frailty among adults 60 years and older based upon results from more than 83,900 participants across Europe, China, Korea, Japan and China. The researchers found that 24% of the older adults were socially fragile, based on assessments in hospitals and in communities. This is a larger percentage than the 12 percent or 9 percent who were deemed cognitively impaired (9%) in separate studies. People 75 years and older were the most vulnerable.
What does this mean for health care? "If someone is socially vulnerable, they might need more support at home while they recover from surgery. They may need to have someone else in their circle of support while they are recovering from surgery.
Jennifer Ailshire, associate professor of sociology and gerontology at the University of Southern California Leonard Davis School of Gerontology, stated that she can see a social fragility index being used to identify older adults who require extra help and direct them to community resources.
Geriatricians screen older adults regularly for additional needs. However, they do not use a consistent or well-vetted set of measures, unlike other doctors. "I'll ask you, "Who are you most dependent on and how do they depend on you?" Visit and see you? You can have their attention and time. "Please give your time and attention," said Dr. William Dale of City of Hope in Duarte California, who holds the Arthur M. Coppola family chair for supportive care medicine at City of Hope.
Dale will either refer the patient to a social worker, or modify the care plan depending on their answers. He cautioned however that specialists and primary care physicians don't always take the time to do so.
Oak Street Health, a Chicago-based company that operates 169 primary care centers in the 21st state for seniors, was recently acquired by CVS Health. Dr. Ali Khan is the chief medical officer of the value-based care strategy.
Medical assistants, social workers, or clinicians interview patients at least three times per year about loneliness, social isolation, transportation barriers, food insecurity and financial strain. They also ask them questions about housing quality and safety, broadband access, and utility services.
This information is combined with the patient's medical information to create a "global risk assessment" that divides older adults into four levels of risk. These range from very high up to very low. This information is used to determine the type of services patients receive, how often they are delivered, and the individual wellness plans that include both medical and social priorities.
Khan stated that the central question is "What is the patient's capacity to continue down a path for resilience in face of a very complex health care system?" What Oak Street Health can do for that.
An approach like this leaves out one crucial thing for older adults: how positive or negative their relationships are with others. Although it isn't usually measured, it is crucial in assessing whether older adults are meeting their social needs, according to Linda Waite, George Herbert Mead distinguished professor of sociology at Chicago and director of National Social Life, Health, and Aging Project.
This five-item index was created by Japanese researchers to help older adults think about their social vulnerability.
Are you going out more often than last year?
Do you visit friends often?
Are you able to help your family and friends?
- Do you live alone?
Do you speak to someone every day or do you just talk with them?
Consider your answers. If your answers are not satisfactory, you might need to reevaluate your social situation and make changes.