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 Social Frailty Influences Depression, Study Says

Social frailty is strongly associated with the incidence of depression in the older adult population, according to a new study in the June issue of JAMDA.

Researchers assessed 3,538 older adults in Japan in terms of depressive symptoms and frailty status, including physical frailty, cognitive impairment, and social frailty. Four years later, they assessed the same people for depressive symptoms and found that 12 percent of the adults with depression also had social frailty, versus 5 percent without any frailty. This compared to 9.6 percent of those with depression and physical frailty and 9.3 percent of those with cognitive impairment and depression.

JAMDA is the journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine.

According to the study, social frailty was defined using five questions, including: going out less frequently compared with last year (“yes”), visiting friends sometimes (“no”), feeling helpful to friends or family (“no”), living alone (“yes”), and talking with someone every day (“no”). Those participants who answered as indicated to one of these questions were considered to have pre-social frailty, and those who answered as indicated to two or more questions were considered to have fully developed social frailty.

One way to address social frailty in older adults is through education, according to the study. “Taking into account the negative impacts of depressive symptoms on both older adults themselves and our society, it may be important for medical professionals to develop interventions for older adults with social frailty to prevent them from developing depressive symptoms,” the study said.

Kota Tsutsumimoto, PhD, lead researcher of the study, says interventions that promote social engagement, “such as sharing a meal with small groups to promote social interaction and giving [elders] a role to improve their efficacy,” may be effective.

At the same time, all factors leading to depressive symptoms are important. “Although our results suggested that social aspects were more important than physical and cognitive aspects in prevention of depressive symptoms, both physical and cognitive function are important factors for older people,” says Tsutsumimoto. “In other words, multiple interventions are thought to be more effective for health promotion in late life.”

Cari Levy, MD, PhD, professor of medicine at the University of Colorado Health Sciences Center and president of the AMDA Board of Directors, says that long term and post-acute care providers can address social isolation by serving as everyday innovators with patients and residents.

They can begin by assessing social connectedness and then working with those in their community to tailor care plans in a manner that preserves or builds upon key components of maintaining social connections,” she says. “Great ideas will surely blossom in the fields of our creativity if we approach the issue as representing an important risk to the health and well-being of older adults.”

And approaching that issue directly means taking a hands-on, person-centered approach, she says.

“Importantly, social isolation cannot be remedied by sliding an iPad in front of someone and hoping they make connections,” says Levi. “Person-centered tailoring is critical both in the means by which we connect older adults socially and the content that provides the connection. There is no way to take shortcuts on personalization of interventions.

“Assess what makes people connect to others, and start developing a care plan that leverages their existing social capitoa and builds upon it,” she says.

Future study, says Tsutsumimoto, should elucidate whether the intervention to alleviate social frailty has an effect on prevention of depressive symptoms among older adults.

The study, titled “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,” was conducted by researchers at the National Center for Geriatrics and Gerontology, the Japan Society for the Promotion of Science, the Kagoshima University School of Health Sciences, and the J.F. Oberlin University Institute of Gerontology, all in Japan.

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