Social fragility, Physical fragility, Frailty syndrome.

Is there a correlation between them?

Courtesy — Freepik

One of the publications in the medical journal Alzheimer’s & Dementia (January 29, 2024) comments that social fragility would be associated with a risk of motoric cognitive risk syndrome (MCR). It is a pre-dementia syndrome characterized by cognitive complaints and slow gait. These findings were suggested from the results of a large population-based study.

Cognition and locomotion are two abilities controlled by the brain. With physiological and pathological aging, the decline of these abilities is highly prevalent. There is an apparent complex interplay between these abilities related to age and an increased intensity when present simultaneously in the same individual.

Thus, poor gait performance may represent a first symptom of dementia.

Frailty is a geriatric syndrome that has been observed with longevity. There are general data that indicate that aging, in developed countries, is accompanied by improvements in general living conditions; on the other hand, in developing countries, there was no adequate reorganization process in the health or social areas.

Longevity is, without a doubt, an achievement resulting from technological advances and health resources, but it is at different stages worldwide, even in countries with similar economic development.

Some authors previously pointed out advanced age, female gender, low education, low income, polypharmacy, lack of family and social support, unhealthy lifestyle habits, cognitive impairment, and hospitalization as the main risk factors for frailty.

These stressors can lead to physical vulnerability with negative outcomes for the health of the elderly.

In this recent publication, the researchers, in the initial assessment of study participants, used five social items to define groups of normal elderly people (zero to one item) and groups of social fragility (two to five items). The social items assessed were: going out less, not feeling confident, rarely visiting friends/family, not talking to other people, and being without a partner/spouse.

MRC was identified in individuals with subjective cognitive complaints and a slow gait speed (criterion determined in comparison with the age-specific level) and without dementia or walking disability. When evaluating participants, demographic data, lifestyle, presence of depression and/or anxiety, and number of chronic diseases were also considered. It is worth noting that participants were evaluated over an average follow-up period of 4 years and 10.35% were diagnosed with MRC.

An important point of the research was the identification that study participants with social frailty had an increased risk of MRC compared to the normal group. And yet another important finding was that each additional unfavorable social item was associated with an increased risk of MRCM, regardless of lifestyle, chronic diseases, and mental health.

The systematic review by Lourenço RA and colleagues {Geriatrics, Gerontology and Aging 2018;12(2):121–35} demonstrated that the prevalence of frailty in Brazilian elderly people ranged between 6.7 and 74.1%. Another important aspect appears in the publication by Cesari M and colleagues {Journal of the American Medical Directors Association 2016 Mar 1;17(3):188–92}; these authors point out that health status in old age is influenced by poorer socioeconomic conditions and poor access to health services during youth and adulthood.

Some researchers have already indicated the existence of a correlation between frailty and social support. Admittedly, older people can become less socially active when they do not have family and social support. Some indicators demonstrate that social support is associated with a protective effect, physical and psychological well-being, and better health conditions may be present.

Several authors indicate that frailty represents a priority in public health and is a prevalent condition in aging populations. This syndrome undoubtedly affects the quality of life of the elderly and also the sustainability of public health systems (according to Cesari et al., 2016).

Frailty, according to several authors (Rodríguez-Mañas et al., 2013; Yeolekar & Sukumaran, 2014; Zaslavsky et al., 2012), is a geriatric syndrome that involves elderly people at a high risk of adverse health events such as falls, hospitalizations, disability, permanent institutionalization, and death.

The definition of physical frailty, alongside social frailty, has been the subject of a growing number of investigations and publications. A biological model, Fried et al (2001), understand that frailty is a cycle characterized by the deterioration of multiple physiological systems that involves weight loss, exhaustion, weakness, low gait speed, and low physical activity. Fragility, according to this model, is present when at least 3 of these 5 factors are identified.

Frailty can be defined as a state of pre-incapacity with physical, psychological, and social loss, under the effect of some variables such as diseases, decreased physiological reserve, and an increased risk of disability and use of healthcare.

Social fragility? Physical fragility? What is the social dimension of frailty syndrome? How many are at risk?

The social dimension of frailty syndrome has been little explored. Effective prevention and intervention programs need to be implemented to identify and guide elderly people at risk.

The social dimension of frailty and the components of this syndrome cannot be neglected. Those closest to an elderly person must be invited to participate and act.

Tavassoli et al (2014) developed an initial questionnaire on symptoms and/or signs to be administered to people aged 65 and over. This questionnaire involves six frailty components (living alone, weight loss, fatigue, mobility, memory, and slowness). An initial state of physical frailty can be determined and social isolation is an important factor in identifying the syndrome.

Many researchers have already explored the relationships between frailty syndrome and several sociodemographic variables, such as being a woman, advanced age, low education, low current socioeconomic position, and housing environment.

Can social factors be related as synonyms of fragility?

Zhang’s study seems to point in that direction.

The review by Lenardt (2021) and the research by ABRATA (Brazilian Association of Family, Friends and People with Affective Disorders) can add a little more to this topic.

The review by Lenardt and colleagues (2021) highlighted the association between depressive symptoms and physical frailty in elderly people, with the capacity to be predictors of each other, and this association is related to negative outcomes for the health of elderly people, including impairment cognitive, activity limitation, increased mortality, among others.

Some data shows that poorer countries have more cases of depression than rich countries.

More than a decade ago, research carried out on behalf of ABRATA demonstrated that classes C and D are the most vulnerable to depression; this research identified depressive symptoms in 25% of people in this social stratum.

Social inequalities involve the main feelings related to depression and other mental disorders, such as humiliation, inferiority, perceived lack of control over the environment, and impotence.

According to the World Health Organization (WHO), depression is the most disabling illness in the world. Even more critical is that depression doesn’t just affect the person who has the disorder; family, friends, and colleagues are also impacted.

Very important were the data recently released by the World Health Organization (WHO) which indicate that, in the coming years, depression is expected to become the most common disease in the world. Depression will affect more people than any other health problem, surpassing cancer and heart disease.

Depression, according to the WHO, will be the disease that will generate the most economic and social costs for governments, given the binomial: spending on treatment for the population and production losses.

The WHO also confirms that poor countries are those that are likely to suffer most from the problem; In these countries, more cases of depression are recorded than in developed countries. In 2009, more than 450 million people were directly affected by mental disorders, the majority of them in developing countries (First Global Mental Health Summit, Athens — Greece).

Dr. Shekhar Saxena (WHO Department of Mental Health) then stated: “The WHO figures clearly showed that the burden of depression (in terms of losses to those affected) is likely to increase so that by 2030, depression alone will be the biggest cause of losses (for the population) among all health problems”.

Everything indicates that social fragility and physical fragility are very close and much closer in the most disadvantaged social strata, here also being associated with a greater frequency of mental disorders that will feed back into the binomial social fragility/physical fragility.

References

• Lenardt MH et al — Sintomas depressivos e fragilidade física em pessoas idosas: revisão integrativa — Rev. Bras. Geriatr. Gerontol. 2021;24(3):e210013
• Bessa BML — A Fragilidade Social — Um contributo para a compreensão da Síndrome de Fragilidade em pessoas idosas — Dissertação Instituto Superior de Serviço Social do Porto (obtenção do Grau de Mestre em Gerontologia Social) — 2016
• Moura K et al — Fragilidade e suporte social de idosos em região vulnerável: uma abordagem em uma Unidade de Saúde da Família — Rev. Aten. Saúde, São Caetano do Sul, v. 18, n. 63, p. 65–73, jan./mar., 2020
• Jesus IT et al — Fragilidade de idosos em vulnerabilidade social — Acta Paul Enferm. 2017; 30(6):614–20.
• Zhang H, Hu Z et al — Social frailty and the incidence of motoric cognitive risk syndrome in older adults — https://doi.org/10.1002/alz.13696 — Alzheimer’s & Dementia — 29 January 2024