Multi-dimensional social frailty index for predicting disability and mortality in community-dwelling older adults:...

We explored the association between a constructed multi-dimensional social frailty index and incidence of disability and all-cause mortality among community-dwelling older adults, examining its prognostic validity.

We obtained data from the 2016 Japan Gerontological Evaluation Study (JAGES), surveying community-dwelling individuals aged ≥65 years, not certified as requiring long-term care, at baseline. The analytical sample comprised 73,472 participants (mean age, 73.7 years; 53.4% women) from 18 municipalities across 10 prefectures in Japan. The social frailty index comprised seven items across four domains: general resources (subjective financial conditions), social resources (living arrangements; social networks [visiting friends]), social behavior/activities (social participation; decreased frequency of going out), and basic social needs fulfillment (emotional social support; social cohesion [community attachment]). Incident disability and all-cause mortality were recorded over a mean 3.5-year follow-up. Associations were examined using Cox proportional hazards models adjusted for demographics, health status, and physical, cognitive, and depressive symptoms.

Participants were classified as socially non-frail (51.6%), socially pre-frail (39.5%), and socially frail (9.0%). Higher social frailty scores were significantly associated with increased risk of disability and mortality. In the demographics and health status-adjusted model, incident disability hazard ratios were 1.41 for social pre-frailty and 1.77 for social frailty, whereas corresponding mortality hazard ratios were 1.35 and 1.65, respectively (all P < 0.001).

The multi-dimensional social frailty index demonstrated robust prognostic validity for adverse health outcomes.

Integrating social dimensions into frailty assessments may facilitate early interventions, inform policy development, and improve health maintenance in aging populations.