Associations Between Social Isolation and Physical Frailty in Older Adults: A Systematic Review and Meta-Analysis.
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AbstractTo the Editor:
The emergence of COVID-19 has drastically changed our daily lives.1 Lockdowns were imposed across many countries for extended periods of time during the pandemic to reduce the risk of infection.1 However, the side effects of lockdowns included loss of opportunities to socialize and interact with other people. Social isolation and its impacts on health have since been highlighted, especially among high-risk populations of older people.1 Social isolation has been well documented as a significant risk factor of mortality, and has also been shown to be associated with poorer physical and mental health.2
Frailty is a geriatric syndrome characterized by cumulative age-related health deficits, decreased physiological reserve, and increased vulnerability to stressors.3,4 Although social isolation and frailty are common in older adults, evidence is limited in the literature regarding the associations between social isolation and frailty.5 The aim of this systematic review and meta-analysis was to investigate the associations between social isolation and frailty in community-dwelling older adults.
Methods
Search Strategy and Study Selection
The protocol was developed according to the PRISMA statements. PubMed was searched in March 2022 without language restriction for longitudinal and cross-sectional observational studies published in 2000 or later providing associations between social isolation and physical frailty. The populations included community-dwelling older adults with a mean age of 60 or older. The search strategy used the Medical Subject Heading (MeSH) and text terms: “social isolation (MeSH)” OR “social isolation” OR “socially isolated” OR “Berkman-syme” OR “Lubben” OR “disconnectedness” AND “frailty (MeSH)” OR “frailty” OR “frailties” OR “frail elderly (MeSH)” OR “frail elderly”. Reference lists of relevant articles were also searched. It was attempted to contact study authors for necessary data. Risks of bias were examined using the 8-item Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies (https://jbi.global/sites/default/files/2019-05/JBI_Critical_Appraisal-Checklist_for_Analytical_Cross_Sectional_Studies2017_0.pdf) and were considered to be low if the score was ≥4 of 8. Odds ratios (ORs) of social isolation and frailty were combined using fixed-effects meta-analysis. Publication bias was examined by visually inspecting a funnel plot. Data analyses were performed using Review Manager 5 (The Cochrane Collaboration, Copenhagen, Denmark).
Results
Among 317 citations identified by the systematic review, 5 cross-sectional studies and 4 longitudinal studies were included in this review (Supplementary Table 1). A fix-effect meta-analysis combining ORs from 3 cross-sectional studies6, 7, 8 showed significant association between social isolation and frailty (3 studies: pooled OR = 1.88; 95% confidence interval = 1.60–2.20; P < .001) (Figure 1). All 3 studies were considered to have low risk of bias (all studies scored 8 of 8). Heterogeneity was low (I2 = 21%; P = .28). It was difficult to assess the funnel plot because of the limited number of the included studies. Longitudinal studies examining associations between social isolation used different statistical methodologies; therefore, they could not be combined by meta-analysis. These studies showed mixed results, most of which did not reach statistical significance.
The emergence of COVID-19 has drastically changed our daily lives.1 Lockdowns were imposed across many countries for extended periods of time during the pandemic to reduce the risk of infection.1 However, the side effects of lockdowns included loss of opportunities to socialize and interact with other people. Social isolation and its impacts on health have since been highlighted, especially among high-risk populations of older people.1 Social isolation has been well documented as a significant risk factor of mortality, and has also been shown to be associated with poorer physical and mental health.2
Frailty is a geriatric syndrome characterized by cumulative age-related health deficits, decreased physiological reserve, and increased vulnerability to stressors.3,4 Although social isolation and frailty are common in older adults, evidence is limited in the literature regarding the associations between social isolation and frailty.5 The aim of this systematic review and meta-analysis was to investigate the associations between social isolation and frailty in community-dwelling older adults.
Methods
Search Strategy and Study Selection
The protocol was developed according to the PRISMA statements. PubMed was searched in March 2022 without language restriction for longitudinal and cross-sectional observational studies published in 2000 or later providing associations between social isolation and physical frailty. The populations included community-dwelling older adults with a mean age of 60 or older. The search strategy used the Medical Subject Heading (MeSH) and text terms: “social isolation (MeSH)” OR “social isolation” OR “socially isolated” OR “Berkman-syme” OR “Lubben” OR “disconnectedness” AND “frailty (MeSH)” OR “frailty” OR “frailties” OR “frail elderly (MeSH)” OR “frail elderly”. Reference lists of relevant articles were also searched. It was attempted to contact study authors for necessary data. Risks of bias were examined using the 8-item Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies (https://jbi.global/sites/default/files/2019-05/JBI_Critical_Appraisal-Checklist_for_Analytical_Cross_Sectional_Studies2017_0.pdf) and were considered to be low if the score was ≥4 of 8. Odds ratios (ORs) of social isolation and frailty were combined using fixed-effects meta-analysis. Publication bias was examined by visually inspecting a funnel plot. Data analyses were performed using Review Manager 5 (The Cochrane Collaboration, Copenhagen, Denmark).
Results
Among 317 citations identified by the systematic review, 5 cross-sectional studies and 4 longitudinal studies were included in this review (Supplementary Table 1). A fix-effect meta-analysis combining ORs from 3 cross-sectional studies6, 7, 8 showed significant association between social isolation and frailty (3 studies: pooled OR = 1.88; 95% confidence interval = 1.60–2.20; P < .001) (Figure 1). All 3 studies were considered to have low risk of bias (all studies scored 8 of 8). Heterogeneity was low (I2 = 21%; P = .28). It was difficult to assess the funnel plot because of the limited number of the included studies. Longitudinal studies examining associations between social isolation used different statistical methodologies; therefore, they could not be combined by meta-analysis. These studies showed mixed results, most of which did not reach statistical significance.
All Author(s) ListKojima G, Aoyama R, Tanabe M
Journal nameJournal of the American Medical Directors Association
Year2022
Month11
Volume Number23
Issue Number11
PublisherElsevier
Pagese3 - e6
ISSN1525-8610
eISSN1538-9375
LanguagesEnglish-United Kingdom