Social isolation in relation to the incidence and dynamic progression of frailty in the oldest old: a trajectory analysis of a nationwide cohort
Abstract Background There is still a lack of evidence examining the association of behavioral and social factors with frailty transitions and mortality. We investigated whether social isolation is associated with different progressions and outcomes of frailty among community-dwelling older adults. M...
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2025-05-01
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| Online Access: | https://doi.org/10.1186/s12889-025-22596-5 |
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| author | Junyi Wang Yafu Yu Lang Xu Xinyan Xie Xiaochang Liu Juan Zhou Guirong Cheng Feifei Hu Dan Liu Linya Huang Gangbin Han Shiyue Li Dan Song Jing Liu Qianqian Nie Cheng Cai Yuyang Cui Wei Tan Yan Zeng |
| author_facet | Junyi Wang Yafu Yu Lang Xu Xinyan Xie Xiaochang Liu Juan Zhou Guirong Cheng Feifei Hu Dan Liu Linya Huang Gangbin Han Shiyue Li Dan Song Jing Liu Qianqian Nie Cheng Cai Yuyang Cui Wei Tan Yan Zeng |
| author_sort | Junyi Wang |
| collection | DOAJ |
| description | Abstract Background There is still a lack of evidence examining the association of behavioral and social factors with frailty transitions and mortality. We investigated whether social isolation is associated with different progressions and outcomes of frailty among community-dwelling older adults. Methods This community-based cohort study assessed the frailty index and objective social isolation of 31,168 participants (58.3% female; average age: 88.1 ± 11.1 years) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2018. Four Markov state-transition models were constructed to examine the associations between social isolation and the seven transitions of the frailty trajectory. Results According to the Markov state-transition model, for every one-point increase in the social isolation score of non-frail participants, the risk of developing prefrailty increased by 4.2% [hazard ratio (HR) = 1.042, 95% confidence interval (CI): 1.007–1.079], whereas for prefrail participants, the risk of developing frailty and death increased by 3.9% (HR = 1.039, 95% CI: 1.007–1.073) and 16.1% (HR = 1.161, 95% CI: 1.099–1.226), respectively. For each increase in the social isolation score in the frail population, the risk of death increased by 2.9% (HR = 1.029, 95% CI: 1.004–1.054). Socially isolated persons had a greater cumulative transition probability to prefrailty and frailty. Socially isolated women were more likely to experience prefrailty and frailty than socially isolated men, whereas the latter were more likely to die from prefrailty and frailty than the former. Conclusions This study indicates that social isolation may contribute to an increased risk of both the incidence and progression of frailty, elevating deterioration risks in initially non-frail and prefrail populations, while primarily exacerbating mortality risks in those already experiencing prefrailty or frailty. |
| format | Article |
| id | doaj-art-4a306ecc4828484dbd22fd8a21958bde |
| institution | Kabale University |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-05-01 |
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| spelling | doaj-art-4a306ecc4828484dbd22fd8a21958bde2025-08-20T03:53:46ZengBMCBMC Public Health1471-24582025-05-0125111110.1186/s12889-025-22596-5Social isolation in relation to the incidence and dynamic progression of frailty in the oldest old: a trajectory analysis of a nationwide cohortJunyi Wang0Yafu Yu1Lang Xu2Xinyan Xie3Xiaochang Liu4Juan Zhou5Guirong Cheng6Feifei Hu7Dan Liu8Linya Huang9Gangbin Han10Shiyue Li11Dan Song12Jing Liu13Qianqian Nie14Cheng Cai15Yuyang Cui16Wei Tan17Yan Zeng18Geriatric Hospital Affiliated to Wuhan University of Science and TechnologyGeriatric Hospital Affiliated to Wuhan University of Science and TechnologyGeriatric Hospital Affiliated to Wuhan University of Science and TechnologyGeriatric Hospital Affiliated to Wuhan University of Science and TechnologyGeriatric Hospital Affiliated to Wuhan University of Science and TechnologyGeriatric Hospital Affiliated to Wuhan University of Science and TechnologyGeriatric Hospital Affiliated to Wuhan University of Science and TechnologyGeriatric Hospital Affiliated to Wuhan University of Science and TechnologyGeriatric Hospital Affiliated to Wuhan University of Science and TechnologyGeriatric Hospital Affiliated to Wuhan University of Science and TechnologyGeriatric Hospital Affiliated to Wuhan University of Science and TechnologyGeriatric Hospital Affiliated to Wuhan University of Science and TechnologyGeriatric Hospital Affiliated to Wuhan University of Science and TechnologyGeriatric Hospital Affiliated to Wuhan University of Science and TechnologyGeriatric Hospital Affiliated to Wuhan University of Science and TechnologyGeriatric Hospital Affiliated to Wuhan University of Science and TechnologyGeriatric Hospital Affiliated to Wuhan University of Science and TechnologyGeriatric Hospital Affiliated to Wuhan University of Science and TechnologyGeriatric Hospital Affiliated to Wuhan University of Science and TechnologyAbstract Background There is still a lack of evidence examining the association of behavioral and social factors with frailty transitions and mortality. We investigated whether social isolation is associated with different progressions and outcomes of frailty among community-dwelling older adults. Methods This community-based cohort study assessed the frailty index and objective social isolation of 31,168 participants (58.3% female; average age: 88.1 ± 11.1 years) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2018. Four Markov state-transition models were constructed to examine the associations between social isolation and the seven transitions of the frailty trajectory. Results According to the Markov state-transition model, for every one-point increase in the social isolation score of non-frail participants, the risk of developing prefrailty increased by 4.2% [hazard ratio (HR) = 1.042, 95% confidence interval (CI): 1.007–1.079], whereas for prefrail participants, the risk of developing frailty and death increased by 3.9% (HR = 1.039, 95% CI: 1.007–1.073) and 16.1% (HR = 1.161, 95% CI: 1.099–1.226), respectively. For each increase in the social isolation score in the frail population, the risk of death increased by 2.9% (HR = 1.029, 95% CI: 1.004–1.054). Socially isolated persons had a greater cumulative transition probability to prefrailty and frailty. Socially isolated women were more likely to experience prefrailty and frailty than socially isolated men, whereas the latter were more likely to die from prefrailty and frailty than the former. Conclusions This study indicates that social isolation may contribute to an increased risk of both the incidence and progression of frailty, elevating deterioration risks in initially non-frail and prefrail populations, while primarily exacerbating mortality risks in those already experiencing prefrailty or frailty.https://doi.org/10.1186/s12889-025-22596-5Social isolationFrailtyMarkov state-transition modelFrailty indexCohort studies |
| spellingShingle | Junyi Wang Yafu Yu Lang Xu Xinyan Xie Xiaochang Liu Juan Zhou Guirong Cheng Feifei Hu Dan Liu Linya Huang Gangbin Han Shiyue Li Dan Song Jing Liu Qianqian Nie Cheng Cai Yuyang Cui Wei Tan Yan Zeng Social isolation in relation to the incidence and dynamic progression of frailty in the oldest old: a trajectory analysis of a nationwide cohort BMC Public Health Social isolation Frailty Markov state-transition model Frailty index Cohort studies |
| title | Social isolation in relation to the incidence and dynamic progression of frailty in the oldest old: a trajectory analysis of a nationwide cohort |
| title_full | Social isolation in relation to the incidence and dynamic progression of frailty in the oldest old: a trajectory analysis of a nationwide cohort |
| title_fullStr | Social isolation in relation to the incidence and dynamic progression of frailty in the oldest old: a trajectory analysis of a nationwide cohort |
| title_full_unstemmed | Social isolation in relation to the incidence and dynamic progression of frailty in the oldest old: a trajectory analysis of a nationwide cohort |
| title_short | Social isolation in relation to the incidence and dynamic progression of frailty in the oldest old: a trajectory analysis of a nationwide cohort |
| title_sort | social isolation in relation to the incidence and dynamic progression of frailty in the oldest old a trajectory analysis of a nationwide cohort |
| topic | Social isolation Frailty Markov state-transition model Frailty index Cohort studies |
| url | https://doi.org/10.1186/s12889-025-22596-5 |
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