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PLOS ONE  2008 

Social Vulnerability, Frailty and Mortality in Elderly People

DOI: 10.1371/journal.pone.0002232

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Abstract:

Background Social vulnerability is related to the health of elderly people, but its measurement and relationship to frailty are controversial. The aims of the present study were to operationalize social vulnerability according to a deficit accumulation approach, to compare social vulnerability and frailty, and to study social vulnerability in relation to mortality. Methods and Findings This is a secondary analysis of community-dwelling elderly people in two cohort studies, the Canadian Study of Health and Aging (CSHA, 1996/7–2001/2; N = 3707) and the National Population Health Survey (NPHS, 1994–2002; N = 2648). Social vulnerability index measures that used self-reported items (23 in NPHS, 40 in CSHA) were constructed. Each measure ranges from 0 (no vulnerability) to 1 (maximum vulnerability). The primary outcome measure was mortality over five (CHSA) or eight (NPHS) years. Associations with age, sex, and frailty (as measured by an analogously constructed frailty index) were also studied. All individuals had some degree of social vulnerability. Women had higher social vulnerability than men, and vulnerability increased with age. Frailty and social vulnerability were moderately correlated. Adjusting for age, sex, and frailty, each additional social ‘deficit’ was associated with an increased odds of mortality (5 years in CSHA, odds ratio = 1.05, 95% confidence interval: 1.02–1.07; 8 years in the NPHS, odds ratio = 1.08, 95% confidence interval: 1.03–1.14). We identified a meaningful survival gradient across quartiles of social vulnerability, and although women had better survival than men, survival for women with high social vulnerability was equivalent to that of men with low vulnerability. Conclusions Social vulnerability is reproducibly related to individual frailty/fitness, but distinct from it. Greater social vulnerability is associated with mortality in older adults. Further study on the measurement and operationalization of social vulnerability, and of its relationships to other important health outcomes, is warranted.

References

[1]  Seeman TE, Berkman LF, Kohout F, Lacroix A, Glynn R, et al. (1993) Intercommunity variations in the association between social ties and mortality in the elderly. A comparative analysis of three communities. Ann Epidemiol 3(4): 325–335.
[2]  Seeman TE, Kaplan GA, Knudsen L, Cohen R, Guralnik J (1987) Social network ties and mortality among the elderly in the Alameda County Study. Am J Epidemiol 126(4): 714–723.
[3]  Blazer DG (1982) Social support and mortality in an elderly community population. Am J Epidemiol 115(5): 684–694.
[4]  Schoenbach VJ, Kaplan BH, Fredman L, Kleinbaum DG (1986) Social ties and mortality in Evans County, Georgia. Am J Epidemiol 123(4): 577–591.
[5]  Bassuk SS, Glass TA, Berkman LF (1999) Social disengagement and incident cognitive decline in community-dwelling elderly persons. Ann Intern Med 131(3): 165–173.
[6]  Andrew MK (2005) Social capital, health, and care home residence among older adults: A secondary analysis of the Health Survey for England 2000. Eur J Ageing 2(2): 137–148.
[7]  Fratiglioni L, Wang HX, Ericsson K, Maytan M, Winblad B (2000) Influence of social network on occurrence of dementia: a community-based longitudinal study. Lancet 355(9212): 1315–1319.
[8]  Mendes de Leon CF, Glass TA, Berkman LF (2003) Social engagement and disability in a community population of older adults: the New Haven EPESE. Am J Epidemiol 157(7): 633–642.
[9]  McCulloch A (2001) Social environments and health: cross sectional national survey. Bmj 323(7306): 208–209.
[10]  Kawachi I, Berkman LF (2000) Social cohesion, social capital, and health. In: Berkman LF, Kawachi I, editors. Social Epidemiology. Oxford: Oxford University Press. pp. 174–190.
[11]  Kawachi I, Kennedy BP, Lochner K, Prothrow-Stith D (1997) Social capital, income inequality, and mortality. Am J Public Health 87(9): 1491–1498.
[12]  Ahmed N, Mandel R, Fain MJ (2007) Frailty: an emerging geriatric syndrome. Am J Med 120(9): 748–753.
[13]  Andrew MK, Mitnitski A (2008) Different ways to think about frailty? Am J Med 121(2): e21.
[14]  Mitnitski AB, Mogilner AJ, Rockwood K (2001) Accumulation of deficits as a proxy measure of aging. Scientific World Journal 1: 323–336.
[15]  Kulminski A, Yashin A, Ukraintseva S, Akushevich I, Arbeev K, et al. (2006) Accumulation of heath disorders as a systemic measure of aging: Findings from the NLTCS data. Mech Ageing Dev.
[16]  Woo J, Goggins W, Sham A, Ho SC (2006) Public health significance of the frailty index. Disabil Rehabil 28(8): 515–521.
[17]  Mitnitski A, Song X, Skoog I, Broe GA, Cox JL, et al. (2005) Relative fitness and frailty of elderly men and women in developed countries, in relation to mortality. J Am Geriatr Soc 53: 2184–2189.
[18]  Rockwood K, Mitnitski A (2006) Limits to deficit accumulation in elderly people. Mech Ageing Dev 127(5): 494–496.
[19]  Rockwood K, McDowell I, Wolfson C (2001) Canadian Study of Health and Aging. International Psychogeriatrics 13: (Suppl. 1)1–237.
[20]  Singh MP, Tambay JL, Krawchuk S (1994) The National Population Health Survey: Design and issues. Ottawa: Statistics Canada.
[21]  Marmot M (2004) Status syndrome: How your social standing directly affects your health and life expectancy. London: Bloomsbury Publishing.
[22]  Grundy E, Holt G (2001) The socioeconomic status of older adults: how should we measure it in studies of health inequalities? J Epidemiol Community Health 55(12): 895–904.
[23]  Grundy E, Sloggett A (2003) Health inequalities in the older population: the role of personal capital, social resources and socio-economic circumstances. Soc Sci Med 56(5): 935–947.
[24]  Mitnitski AB, Song X, Rockwood K (2004) The estimation of relative fitness and frailty in community-dwelling older adults using self-report data. J Gerontol A Biol Sci Med Sci 59(6): M627–632.
[25]  Armitage P, Berry G, Matthews JNS (2002) Statistical methods in medical research. Fourth edition 298–306.
[26]  Rockwood K, Abeysundera MJ, Mitnitski A (2007) How should we grade frailty in nursing home patients? J Am Med Dir Assoc 8(9): 595–603.
[27]  Rockwood K, Andrew M, Mitnitski A (2007) A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci 62(7): 738–743.
[28]  Rockwood K, Mitnitski A, Song X, Steen B, Skoog I (2006) Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70. J Am Geriatr Soc 54(6): 975–979.
[29]  Fratiglioni L, Paillard-Borg S, Winblad B (2004) An active and socially integrated lifestyle in late life might protect against dementia. Lancet Neurol 3(6): 343–353.
[30]  Wang HX, Karp A, Winblad B, Fratiglioni L (2002) Late-life engagement in social and leisure activities is associated with a decreased risk of dementia: a longitudinal study from the Kungsholmen project. Am J Epidemiol 155(12): 1081–1087.
[31]  Lochner KA, Kawachi I, Brennan RT, Buka SL (2003) Social capital and neighborhood mortality rates in Chicago. Soc Sci Med 56(8): 1797–1805.
[32]  Wilkinson RG (1996) Unhealthy societies: The afflictions of inequality. London: Routledge.
[33]  Andrew MK (2005) Le capital social et la santé des personnes agées. Retraite et Société 46: 129–143.
[34]  Hepburn KW (2003) Social Gerontology. In: Tallis R, Fillit H, editors. Brocklehurst's textbook of geriatric medicine and gerontology. 6th ed. London: Churchill Livingston. pp. 183–191.
[35]  Mitnitski A, Bao L, Rockwood K (2006) Going from bad to worse: a stochastic model of transitions in deficit accumulation, in relation to mortality. Mech Ageing Dev 127(5): 490–493.

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