
==== Front
BMC Geriatr
BMC Geriatr
BMC Geriatrics
1471-2318
BioMed Central London

5365
10.1186/s12877-024-05365-8
Systematic Review
Prevalence and potential influencing factors for social frailty among community-dwelling older adults: a systematic review and meta-analysis
Li Jie 12
Zhu Linfang 12
Yang Yujie 12
Li Yajuan 12
Fu Ping 1
Yuan Huaihong yuanhuaihong@wchscu.cn

12
1 grid.412901.f 0000 0004 1770 1022 Department of Nephrology, Institute of Kidney Diseases, West China Hospital, Sichuan University, Chengdu, 610041 China
2 https://ror.org/011ashp19 grid.13291.38 0000 0001 0807 1581 West China School of Nursing, Sichuan University, Chengdu, 610041 China
16 9 2024
16 9 2024
2024
24 76229 4 2024
6 9 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Objective

To explore the prevalence and potential influencing factors of social frailty among community-dwelling older adults from a global perspective.

Methods

Systematic searches were conducted on multiple databases including CNKI, VIP, Wanfang Data, CBM, Pubmed, Cochrane Library, Web of Science, and Embase from inception to January 9, 2024. Two researchers performed a thorough literature search, gathered data, and independently evaluated the quality of the articles.

Results

2,426 literatures were examined, 45 were found to meet the specified criteria for inclusion, encompassing 314,454 participants. The combined prevalence of social pre-frailty and social frailty among community-dwelling older adults were found to be 34.5% and 21.1%, respectively. Depression, activities of daily living (ADL), physical inactivity, motor deficits, cognitive impairment, and physical frailty are potential risk factors.

Conclusions

Social pre-frailty and social frailty are frequent challenges faced by older adults living in the community. The prevalence of these conditions has been on the rise in recent years, underscoring the importance of implementing effective interventions. Early identification and intervention for individuals at risk of social frailty are essential for promoting healthy and active aging globally.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-024-05365-8.

Keywords

Older adults
Community-dwelling
Social frailty
Prevalence
Risk factors
Project for disciplines of excellence from West China Hospital of Sichuan UniversityZYGD23015 ZYGD23015 ZYGD23015 ZYGD23015 ZYGD23015 ZYGD23015 issue-copyright-statement© BioMed Central Ltd., part of Springer Nature 2024
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pmcIntroduction

The United Nations World Population Prospects points out that population aging is a major global trend. In the modern era, the challenges of a decline in the birth rate and aging societies in different nations have gained attention. It is estimated that by 2050, there will be more than 1.5 billion people aged 65 and over around the world [1]. As we grow older, our physical health and functional capacities naturally decrease. Hence, giving priority to the well-being of elderly individuals is a crucial component of healthcare that can enhance their quality of life and foster a healthy, active aging process.

Frailty is a condition associated with aging in which physiological reserves decrease [2]. Studies have shown that frailty is linked to a higher likelihood of experiencing falls, being hospitalized, developing disabilities, and even facing mortality [3]. Assessing the health of older adults has emerged as a crucial metric, garnering global recognition and interest from nations worldwide. Social frailty is a concept that refers to the lack or loss of social resources, behaviors, activities, and self-management skills needed to fulfill fundamental social needs [4]. According to the social production theory, these social needs include emotional needs, the need for behavior to be recognized, and the need for identity roles to be recognized [4]. This condition can occur at any stage of life and can have a significant impact on an individual’s overall well-being and quality of life [5]. Although frailty and social frailty are distinct concepts, they often and increasingly coexist [6]. Moreover, similar to frailty, the incidence of social frailty is on the rise and is closely linked to various negative consequences, such as physical impairment, cognitive decline, mood disorders, and even death [7].

Understanding the worldwide prevalence of social frailty can help policymakers evaluate the scope and severity of the problem, support continuous monitoring of at-risk populations, and direct clinical research efforts and public health surveillance. Some studies have examined social frailty among older adults living in the community, but the results are limited to specific countries. Although a meta-analysis [8] indicated that approximately 14.9 − 22.7% of older adults residing in community experience social frailty, the analysis merely offered a basic overview without delving into detailed quantitative assessments of prevalence and risk factors within the community demographic.

Therefore, we conducted this study to update the latest evidence on the prevalence and potential influencing factors of social frailty among older people in communities worldwide. This approach aims to offer healthcare experts with a broader scope of data, as well as furnish evidence-based backing for the formulation of pertinent health and social service protocols.

Methods

The study protocol had been registered on PROSPERO (CRD42022323690) and was conducted following PRISMA [9] and MOOSE [10] guidelines.

Search strategies

Systematic searches were conducted at CNKI, VIP, Wanfang Data, CBM, Pubmed, Cochrane Library, Web of Science, and Embase from the establishment of the database to January 9, 2024. The search was confined to both the Chinese and English languages. Additionally, a thorough manual examination of the sources obtained in the studies was carried out to guarantee comprehensiveness of the search. Details of the search strategy were as follows: (aged OR elder* OR older*) AND (social frailty OR social vulnerability OR frailty OR pre-frail* OR frailty syndrome).

Selection criteria

Inclusion criteria: (a) study design included cross-sectional or cohort studies; (b) participants were older adults living in communities, aged ≥ 60 years old; (c) outcome indicators were the prevalence and potential influencing factors of social frailty; (d) diagnostic criteria: diagnosis of social frailty had to be made using social frailty diagnostic tools such as: Makizako social Frailty Index (MSFI)、Help、participation、loneliness、financial、talk scale (HALEFT)、Tilbury Frailty Indicator (TFI)、Social Frailty Index (SFI)、Social frailty screening questionnaire (SFSQ)、Social frailty questionnaire (SFQ)、Social vulnerability index (SVI)、Lubben social network scale (LSNS-6 ) and Bunt; and (e) relevant studies were included regardless of the quality of the literature.

Exclusion criteria: (a) literature type of review, conference paper or abstract; (b) duplicate publications; (c) literature for which full text or required data were not available.

Study selection

Two researchers (L.J and Z.L.F) conducted the screening process of the studies independently. When two researchers had different opinions, the third researcher (Y.Y.J) was asked. Initially, duplicates were eliminated, then titles and abstracts were reviewed to exclude clearly irrelevant literature. Afterwards, the entire texts underwent examination, and the ultimate incorporation of literature was established according to inclusion criteria. Any discrepancies were addressed through discourse and mediation with a third researcher. The data sheet with standard formatting contained the subsequent information: study author, publication year, country/region, mean age, study type, sample size, prevalence and factors influencing social frailty/pre-social frailty, and assessment tool.

Quality assessment

Two researchers (L.J and Z.L.F) assessed the quality of included studies using Agency for Healthcare and Research and Quality tool (AHRQ) [11] and the Newcastle–Ottawa Scale (NOS) [12]. When two researchers had different opinions, the third researcher (Y.Y.J) was asked. AHRQ is used to assess the quality of the cross-sectional studies. The scale consists of 11 items with responses categorized as ‘yes’, ‘no’, or ‘unclear’. Each ‘yes’ response is counted as 1, while ‘no’ or ‘unclear’ responses are counted as 0. The total score is calculated by summing the scores of each item, ranging from 0 to 11. NOS is used to assess the quality of the cohort studies. The scale consists of 8 items with a maximum score of 9. Each study is classified as poor, fair, or good quality.

Statistical analysis

The research aimed to analyze the pooled prevalence and 95% confidence intervals (CIs) of social frailty in older adults living in the communities. Furthermore, factors linked to social frailty were evaluated by computing the collective odds ratio (OR) and corresponding 95% CIs. Heterogeneity testing was performed using Stata 17.0 software. If the heterogeneity test I2 was less than 50%, it was considered as moderate or low heterogeneity, and the analysis was performed using a fixed-effects model. If I2 was 50% or higher, a random-effects model was used. The significance level for the Meta-analysis was set at α = 0.05. To address any noticeable clinical heterogeneity, we utilized methods such as subgroup analysis, sensitivity analysis, or descriptive analysis. Sensitivity analysis involved systematically excluding individual studies one by one. Publication bias was assessed through funnel plots and Egger’s test.

Results

Study selection

In our study, a total of 2426 studies were searched, with contributions from CNKI (n = 117), VIP (n = 73), Wanfang (n = 47), CBM (n = 53), Pubmed (n = 700), WOS (n = 588), Embase (n = 400), and Cochrane Library (n = 448). Among these, 473 studies were found to be duplicates, 1855 were excluded based on title and abstract screening, 98 underwent full-text reading rescreening, and ultimately 45 studies were included in the Meta-analysis. Figure 1. Flow diagram of study selection.

Fig. 1 Flow diagram of study selection

Study characteristics

45 studies were included, and Table 1 summarizes the characteristics of these studies. These studies were published between 2015 and 2023, encompassing 314,454 participants from eight different countries. All study sites were community-based, comprising 34 cross-sectional studies and 11 cohort studies. Sample sizes varied from 103 to 222,179 individuals. Various assessments were utilized across studies to diagnose social frailty, including MSFI, HALFT, TFI, SFI, SFSQ, SFQ-9, SFQ-6, SVI, LSNS-6, and Bunt. The most frequently employed tool for assessing social frailty was the MSFI, utilized in 22 of the studies.

Table 1 Characteristics of included studies

Author/Year	Country/region	Mean age	Sample source	Study type	Sample size	Male/Female	Social frailty assessment	Prevalence(%)	Related factors	quality assessment score	
Social frailty	Social pre-frailty	
Makizako [13]	Japan	71.7 ± 5.3	Community	prospective cohort study	4304	2097/2207	MSFI	10.2	24.9	-	9	
Tsutsumimoto [14]	Japan	71.9 ± 5.5	Community	cross-sectional study	4425	2151/2274	MSFI	11.1	24.8	a、b、c	6	
Ma [15]	China	≥ 60	Community	prospective cohort study	1697	-	HALFT	7.7	45.3	-	7	
Makizako [16]	Japan	70.4 ± 4.1	Community	cross-sectional study	1226	593/633	MFSI	3.6	20.4	b	11	
Rietman [17]	the Netherlands	64.7 ± 9.4	Community	prospective cohort study	3117	1415/1702	TFI	5.2	-	-	8	
Teo [18]	Singapore	66.1 ± 7.6	Community	cross-sectional study	2406	1702/704	SFI	18.4	-	d	9	
Tsutsumimoto [19]	Japan	71.3 ± 0.08	Community	prospective cohort study	3538	1718/1820	MSFI	10.2	-	e	7	
Yamada [20]	Japan	75.2 ± 6.6	Community	prospective cohort study	6603	2911/3692	MSFI	18.0	32.1	-	8	
Hirase [21]	Australian	79.1 ± 6.0	Community	cross-sectional study	248	42/206	MSFI	22.2	-	-	9	
Jang [22]	Korea	75.0 ± 5.5	Community	cross-sectional study	408	172/236	MSFI	20.6	29.7	a、d、e	9	
Makizako [23]	Japan	75.4 ± 6.5	Community	cross-sectional study	363	89/264	MSFI	14.3	-	-	6	
Nakakubo [24]	Japan	71.9 ± 5.5	Community	cross-sectional study	4427	2153/2274	MSFI	11.2	24.7	-	7	
Park [25]	Korea	74.9 ± 6.0	Community	cross-sectional study	408	172/236	MSFI	20.6	29.7	-	7	
Tsutsumimoto [26]	Japan	71.7 ± 5.3	Community	prospective cohort study	3720	1800/1920	MSFI	18.4	-	-	8	
Verver [27]	the Netherlands	≥ 65	Community	cross-sectional study	1768	-	TFI	18.4	-	-	10	
Yoo [28]	Korea	75.7 ± 4.0	Community	cross-sectional study	1539	724/815	MSFI	11.7	60.7	-	8	
Zhang [29]	China	79.7 ± 5.6	Community	cross-sectional study	2167	854/1313	TFI	29.0	-	-	9	
Hironaka [30]	Japan	73.3 ± 6.6	Community	cross-sectional study	682	267/415	MSFI	23.2	34.8	-	9	
Huang [31]	Japan	69.7 ± 4.4	Community	cross-sectional study	666	-	SFSQ	37.5	-	-	7	
Pek [32]	Singapore	67.2 ± 7.4	Community	cross-sectional study	229	62/167	SFQ−9	7.4	28.8	e、c、f	7	
Zhang [33]	China	69.9 ± 6.2	Community	cross-sectional study	359	149/210	HALFT	10.9	-	-	8	
Peng [34]	China	≥ 60	Community	cross-sectional study	313	184/129	HALFT	27.2	41.2	-	7	
Chen [35]	China	≥ 70	Community	cross-sectional study	1764	944/820	SFQ−6	3.5	-	e	8	
Huang [36]	Japan	69.5 ± 4.5	Community	prospective cohort study	666	291/375	SFSQ	6.3	31.1	-	7	
Ko [37]	Korea	74.5 ± 6.2	Community	cross-sectional study	10,081	-	MSFI	44.7	-	-	7	
Ono [38]	Japan	79.4 ± 3.5	Community	prospective cohort study	748	398/350	MSFI	23.3	-	c	7	
Song [39]	China	73.9 ± 5.8	Community	cross-sectional study	516	224/292	HALFT	12.8	-	f	8	
Liu [40]	China	≥ 60	Community	cross-sectional study	194	104/90	TFI	39.2	-	-	7	
Hao [41]	China	≥ 60	Community	cross-sectional study	454	262/192	HALFT	11.2	-	d、e	7	
Chen [42]	China	≥ 65	Community	cross-sectional study	2987	1358/1629	HALFT	25.9	-	d	8	
Choi [43]	Korea	73.4 ± 6.5	Community	cross-sectional study	9920	-	HALFT	51.3	31.9	-	8	
Doi [44]	Japan	70.9 ± 4.7	Community	prospective cohort study	4642	-	MSFI	44.6	-	-	6	
Hayashi [45]	Japan	81.1 ± 5.0	Community	cross-sectional study	1103	507/596	SFSI	15.3	32.5	e、f	8	
Ko [46]	Korea	≥ 65	Community	cross-sectional study	735	234/501	MSFI	48.4	31	-	6	
Kodama [47]	Japan	≥ 60	Community	cross-sectional study	103	72/31	MSFI	10.7	28.2	e	9	
Kume [48]	Japan	75.0 ± 5.8	Community	cross-sectional study	313	-	MSFI	21.7	31.3	e	9	
Miyata [49]	Japan	74.2 ± 6.4	Community	cross-sectional study	596	217/379	MSFI	18.6	-	-	8	
Sugie [50]	Japan	81.5 ± 4.5	Community	cross-sectional study	268	-	LSNS−6	8.2	-	-	6	
Ferreira [51]	Brazil	≥ 60	Community	cross-sectional study	805	267/538	SVI	71.1	-	-	6	
Ragusa [52]	England	70.7 ± 7.7	Community	cross-sectional study	4149	2133/2016	Bunt	43.0	38.9	-	8	
Yang [53]	China	≥ 60	Community	cross-sectional study	471	-	HALFT	38.4	-	-	6	
Chen [54]	China	≥ 65	Community	cross-sectional study	208	125/83	MSFI	45.7	-	-	7	
Jeong [55]	China	≥ 60	Community	cross-sectional study	6479	-	MSFI	24.8	40.1	-	6	
Qi [56]	China	≥ 60	Community	cross-sectional study	222,179	-	HALFT	15.2	-	-	8	
Sun [57]	China	71	Community	cross-sectional study	460	-	SFSQ	24.3	-	-	7	
Note: a:cognitive function; b:frailty; c:motor dysfunction; d: difficulties in ADLs; e:depression; f: physical inactivity;-:no report

Methodological quality

Table 1 presents the results of the methodological quality assessment for all 45 studies in this systematic evaluation. In cross-sectional studies, 19 studies were categorized as low risk of bias and 17 studies were categorized as moderate risk of bias. In cohort studies, 5 studies were categorized as low risk of bias and 4 studies were categorized as moderate risk of bias. The most common cause of risk of bias were the failure to report non-response rates and the number and cause of missing data.

Prevalence of social frailty and social pre-frailty

A total of 45 studies, involving 314,454 individuals, were included in the meta-analysis on the prevalence of social frailty. The prevalence of social frailty varied from 3.5 to 71.1% among the studies. According to the random-effects model, the combined prevalence of social frailty in older adults living in the community was calculated to be 21.1% (95% CI = 17.8–24.5%). Considerable heterogeneity was noted among the 45 studies included in the analysis (I2 = 99.7%, Q = 15583.9, P < 0.001). Among these, 23 studies provided estimates of the prevalence of social pre-frailty in older adults living in the community, with prevalence rates ranging from 20.4 to 60.7%. The random-effects model revealed a combined prevalence of social pre-frailty in community-dwelling older adults at 34.5% (95% CI = 30.9–38.0%). A significant level of heterogeneity between studies was evident (I2 = 98.7%, Q = 1589.82, P < 0.001).

Subgroup analysis and meta-regression analysis

To explore the heterogeneity among studies, we conducted subgroup analyses based on study design, sample size, region, country, time of publication, and diagnostic criteria for social decline.Table 2 demonstrates the specific results of the subgroup analysis In addition, we performed meta-regression analysis.The details are shown in Table 3.

For the meta-regression analyses, associations between prevalence of frailty and study characteristics including study design, sample size, region, country, publication time, and diagnostic criteria for social frailty were assessed by univariate and multivariate meta-regression analyses. In the multivariate meta-regression model, country (β= -0.14, 95% CI = -0.27- -0.16, P = 0.02), and time to publication (β= -0.11, 95% CI = -0.19-0.02, P = 0.02) were associated with prevalence of social frailty. The remaining factors were not significantly associated with the prevalence of social debility.

Table 2 Subgroup analyses by study design, sex, region, social frailty assessment and publication time

Subgroups	Number of studies	Social frailty Prevalence	95%CI	I2	P value	
Study design						
 Cross-sectional study	34	24%	19–28%	99.7%	<0.001	
 Prospective cohort study	11	19%	12–25%	99.7%	<0.001	
Sample size						
 ≤ 500	34	18%	15–20%	98.5%	<0.001	
 >500	11	35%	25–45%	99.9%	<0.001	
Region						
 Asia	40	21%	18–25%	99.7%	<0.001	
 Other regions	5	32%	10–54%	99.9%	<0.001	
Country						
 Japan	18	17%	13–21%	99.4%	<0.001	
 China	13	22%	17–26%	99.2%	<0.001	
 Korea	7	32%	20–44%	99.8%	<0.001	
 Other contries	7	27%	11–42%	99.8%	<0.001	
Social frailty assessment						
 MSFI	23	23%	16–29%	99.8%	<0.001	
 HALFT	8	18%	14–23%	99.9%	<0.001	
 TFI	4	23%	9–36%	99.6%	<0.001	
 SFQ	5	18%	8–28%	98.5%	<0.001	
 Other assessments	5	29%	8–50%	99.8%	<0.001	
Publication time						
 2015–2019	17	15%	12–17%	98.8%	<0.001	
 2020–2023	28	27%	21–33%	99.8%	<0.001	

Table 3 Results of meta-regression analysis

Subgroups	β	SE	95%CI	P value	
Study design	0.02	0.05	−0.08−0.12	0.68	
Sample size	−2.51	6.95	−1.65−1.15	0.72	
Region	0.11	0.07	−0.03−0.25	0.13	
Country	−0.14	0.06	−0.27-−0.16	0.03	
Social frailty assessment	0.06	0.10	−0.15−0.27	0.57	
Publication time	−0.11	0.04	−0.19−0.02	0.02	

Risk factors associated with social frailty

There were 8 studies reporting on depression, 4 on difficulties in ADLs, 4 on physical inactivity, 3 on motor dysfunction, 2 on cognitive functioning, and 2 on physical frailty.Meta-analysis results showed that depression, difficulties in ADLs, physical inactivity, motor dysfunction, cognitive deficits, and physical frailty were the risk factors for social frailty in community-dwelling older adults. Specific results are shown in Table 4.

Table 4 Results of meta-analysis of risk factors for social frailty among community-dwelling older adults

Relevant factors	Number of studies	OR(95%CI)	P value	Analysis model	Heterogeneity	
P value	I2	
Depression	8	1.86[1.43,2.42]	<0.0001	random	0.003	68%	
difficulties in ADLs	4	2.57[1.47,4.50]	0.0009	random	<0.001	87%	
physical inactivity	3	2.54[1.60,4.05]	<0.0001	fixed	0.63	0%	
Motor dysfunction	3	1.99[1.64,2.43]	<0.0001	fixed	0.47	0%	
Cognitive function	2	1.67[1.22,2.29]	0.001	fixed	0.65	0%	
Frailty	2	2.03[1.61,2.57]	<0.001	fixed	0.33	0%	

Sensitivity analysis and publication of bias

Sensitivity analysis was conducted by excluding individual studies one by one, revealing that the combined prevalence of social frailty ranged from 17.8 to 24.5%. This range was found to be not significantly different from the overall prevalence results, indicating the stability of the meta-analysis findings. The funnel diagram of prevalence studies on social debility showed no significant asymmetry. Additionally, the results of Egger’s test (P = 0.138) suggest a low probability of publication bias.

Discussion

Summary of findings

Although the prevalence of social frailty is relatively high, consensus on how to define and measure it is insufficient [58]. Social frailty is defined as a continuum of being at risk of losing, or having lost, resources that are important for fulfilling one or more basic social needs during one’s life span [4].

Our study is the first to systematically examine the prevalence and influencing factors of social frailty in community-dwelling older adults, revealing unique and significant findings. Our meta-analysis introduced the prevalence of social frailty in this population(21.1%) for the first time, showing that social frailty is more prevalent than physical frailty (10.7%, 95%CI: 10.5-10.9%) [59] and cognitive frailty (9%, 95% CI: 8-11%) [60] globally. This highlights the importance of addressing social factors associated with frailty in older adults to improve social participation, sense of belonging, and promote active and healthy aging as society and economy evolve. More interestingly, we also found that the pooled prevalence of pre-social frailty in community-dwelling older adults (34.5%) was much higher than the pooled prevalence of social frailty. It indicates that pre-social frailty is a larger population base than social frailty. This finding suggests that screening and interventions for community-dwelling older adults with pre-social frailty may provide an opportunity for effective management of social frailty and improved health outcomes.

Among the included studies, we found a high degree of heterogeneity. To explore the sources of this heterogeneity, we conducted subgroup analyses and meta-regression analyses to assess the characteristics of the included studies. Our analyses found that the pooled prevalence of the prevalence of social frailty among community-dwelling older adults based on cross-sectional study designs differed significantly from the pooled prevalence based on cohort study designs, suggesting that study design and sample size affect the pooled prevalence results and may be a source of heterogeneity. The occurrence of such differences can be explained by the fact that 14 of the 34 cross-sectional studies and 1 of the 11 cohort studies we included had sample sizes < 500, which may have led to less accurate results. For studies with a sample size of more than 500, 6 cross-sectional studies out of 11 reported a prevalence of 40% or more of social decline in community-dwelling older adults, which may explain the higher pooled prevalence in cross-sectional studies than in cohort studies.Zhang et al.’ study also supported the same conclusion [8].

Out of the 45 studies reviewed, 40 focused on surveys of older individuals in Asia, representing 96.8% of the total population. The majority of these studies were conducted in China, Japan, and South Korea, reflecting the significant size of aging population in these countries due to factors such as super-aging, low birth rates, and increasing rates of living alone. It has been reported that the Asia Pacific population is ageing faster than any other region in the world, accounting for 60% of the global population in 2022 and an estimated 55% by the year 2050 [61]. It is projected that the number of older adults in Asia Pacific who are aged 60 and over will rise from 549 million in 2017 to around 1.3 billion by the year 2050 [61]. This increased number of older adults may lead to the prevalence of frailty status, growing burdens on society, and various health outcomes [62]. Consequently, the prevalence findings derived from this collective analysis are more likely to reflect the prevalence of social vulnerability among older adults living in communities in Asia compared to other regions, influenced by factors such as geographical location, economic status, and cultural diversity. This highlights the need for future research to explore the epidemiology and causes of social vulnerability among older adults in non-Asian regions to establish consistent criteria for assessing social frailty and gain a more comprehensive understanding of its global prevalence.

Various assessment tools have been developed for social frailty due to the lack of a standardized concept. This systematic review focused on 11 assessment tools for social frailty in older adults, with the most commonly used being the MSFI, identified in 23 studies with a pooled prevalence of 23%. Following closely was the HALFT scale, utilized in 8 studies with a pooled prevalence of 19%. Upon further analysis, it was noted that 14 out of the 23 studies employing the MSFI scale were conducted in Japan. Given Japan’s status as the country with the highest proportion of older adults globally, this may explain the higher prevalence of social frailty detected by the MSFI scale in these studies.

According to the results of the time-stratified analysis, we found that the prevalence of social frailty increased year by year. The prevalence of frailty was 15% range 2015 from 2019 to 27% range 2020 from 2023. From 2015 to 2019, there were only 17 studies involving 42,364 participants, compared to 28 studies involving 272,090 participants from 2020 to 2023. An increase in sample size and a better understanding of the concept of social frailty may explain the higher combined prevalence estimates for 2020 to 2023. In addition, another reason for this trend may be related to the COVID-19 outbreak in 2019 [58]. In the context of major public health events, the older adults’s social activities with the outside world are reduced, the behavior of staying at home and sitting down is increased, and the older people are unable to skillfully use social software and cut off communication with the outside world, which may increase the occurrence of social weakness.

In terms of risk factors for social frailty in older people in the community, depression was found to be significantly associated with social frailty, which is consistent with previous findings [63]. This may be due to the older adults with depressed mood lose interest in life, avoid social behavior, resulting in a decline in social participation. Difficulties in ADLs, physical inactivity and motor dysfunction are risk factors for social frailty. When the older adults have impaired motor function, it will lead to low ADL ability of the older adults, and the number of physical activities will be reduced, and regular physical activities will help slow down the process of physical weakness of the older adults. Studies [64] have pointed to regular exercise as the preferred method for boosting self-efficacy, self-esteem and awareness of body intention. When the number of physical activities is reduced, the discomfort of physical function, psychological emotion and interpersonal communication in the older adults is enhanced, and the risk of social frailty is increased. Therefore, community workers should pay attention to outdoor activities for the older adults, such as community collective activities and participation in regional activities to promote physical improvement.

The study also showed that older adults with cognitive deficits had a 1.67-fold increased risk of social frailty. Previous studies have also shown a clear correlation between cognitive decline and low social participation in later life [65]. The possible mechanism is that the social pressure causes the disorder of multiple system organs in the body, and finally affects the cognitive function [66]. Therefore, taking measures to prevent cognitive decline in the older adults will help prevent or delay the occurrence of social frailty. This study also shows that social frailty is closely related to physical frailty. Nagai et al.’ study also supported the same conclusion [67]. Previous studies have demonstrated that social frailty in older adults can precede and lead to physical frailty, is associated with multiple adverse health outcomes, and is predictive of death [68]. Therefore, it is of great significance to evaluate and intervene the social aspects of senile frailty.

Limitations

Several limitations should be considered.First, papers that were not written in Chinese or English were excluded due to lack of resources, which may cause language bias. Second, gray literature was not searched in this study, which may affect the results of Meta-analysis. Third, there was significant heterogeneity in the meta-analysis of prevalence.We found that country and publication time could explain some of the differences. In addition, sensitivity analysis and Egger’s test showed the reliability and low publication bias of our study. Finally, the 45 studies included in this study used different diagnostic criteria for social debility, which may have led to a slight bias between the preliminary findings.

Conclusion

This systematic review showed that prevalence of pre-social frailty and social frailty is common among older adults living in community-based settings and that there are more factors influencing it. In addition, the prevalence of social frailty has continued to increase in recent years. In the context of healthy aging, social frailty in community-dwelling older adults deserves widespread attention by health care workers.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Acknowledgements

We thank West China Hospital of Sichuan University and West China College of Nursing of Sichuan University for technical support.

Author contributions

JL conducts major thesis writing, data extraction and data analysis, and article proofreading. LZ conducts thesis writing, data extraction and partial data analysis. YY, and YL provided ideas. HY, and PF provides ideas for papers and reviews articles. All authors contributed to the article and approved the submitted version.

Funding

This study is supported by the 1·3·5 project for disciplines of excellence from West China Hospital of Sichuan University (ZYGD23015).

Data availability

The data that support the findings of this study are openly available in CNKI, VIP, Wanfang Data, CBM, Pubmed, Cochrane Library, Web of Science, and Embase.

Declarations

Ethics approval and consent to participate

Not applicable

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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References

1. Zarocostas J The UN reports global asymmetries in population growth Lancet 2022 400 10347 148 10.1016/S0140-6736(22)01323-X 35843232
Zarocostas J. The UN reports global asymmetries in population growth. Lancet. 2022;400(10347):148.35843232 10.1016/S0140-6736(22)01323-X
2. Clegg A Young J Iliffe S Rikkert MO Rockwood K Frailty in elderly people Lancet 2013 381 9868 752 62 10.1016/S0140-6736(12)62167-9 23395245
Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.23395245 10.1016/S0140-6736(12)62167-9
3. Hoogendijk EO Afilalo J Ensrud KE Kowal P Onder G Fried LP Frailty: implications for clinical practice and public health Lancet 2019 394 10206 1365 75 10.1016/S0140-6736(19)31786-6 31609228
Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019;394(10206):1365–75.31609228 10.1016/S0140-6736(19)31786-6
4. Bunt S Steverink N Olthof J van der Schans CP Hobbelen JSM Social Frailty in older adults: a scoping review Eur J Ageing 2017 14 3 323 34 10.1007/s10433-017-0414-7 28936141
Bunt S, Steverink N, Olthof J, van der Schans CP, Hobbelen JSM. Social Frailty in older adults: a scoping review. Eur J Ageing. 2017;14(3):323–34.28936141 10.1007/s10433-017-0414-7
5. Andrew MK Frailty and Social Vulnerability Interdisciplinary Top Gerontol Geriatr 2015 41 186 95 10.1159/000381236
Andrew MK. Frailty and Social Vulnerability. Interdisciplinary Top Gerontol Geriatr. 2015;41:186–95.10.1159/000381236
6. Hanlon P Wightman H Politis M Kirkpatrick S Jones C Andrew MK Vetrano DL Dent E Hoogendijk EO The relationship between frailty and social vulnerability: a systematic review Lancet Healthy Longev 2024 5 3 e214 26 10.1016/S2666-7568(23)00263-5 38432249
Hanlon P, Wightman H, Politis M, Kirkpatrick S, Jones C, Andrew MK, Vetrano DL, Dent E, Hoogendijk EO. The relationship between frailty and social vulnerability: a systematic review. Lancet Healthy Longev. 2024;5(3):e214–26.38432249 10.1016/S2666-7568(23)00263-5
7. Goto T Kishimoto T Fujiwara S Shirayama Y Ichikawa T Social Frailty as a predictor of all-cause mortality and functional disability: a systematic review and meta-analysis Sci Rep 2024 14 1 3410 10.1038/s41598-024-53984-3 38341512
Goto T, Kishimoto T, Fujiwara S, Shirayama Y, Ichikawa T. Social Frailty as a predictor of all-cause mortality and functional disability: a systematic review and meta-analysis. Sci Rep. 2024;14(1):3410.38341512 10.1038/s41598-024-53984-3
8. Zhang XM Cao S Gao M Xiao S Xie X Wu X The prevalence of Social Frailty among older adults: a systematic review and Meta-analysis J Am Med Dir Assoc 2023 24 1 29 e3729 10.1016/j.jamda.2022.10.007 36402197
Zhang XM, Cao S, Gao M, Xiao S, Xie X, Wu X. The prevalence of Social Frailty among older adults: a systematic review and Meta-analysis. J Am Med Dir Assoc. 2023;24(1):29–e3729.36402197 10.1016/j.jamda.2022.10.007
9. Page MJ McKenzie JE Bossuyt PM Boutron I Hoffmann TC Mulrow CD Shamseer L Tetzlaff JM Akl EA Brennan SE The PRISMA 2020 statement: an updated guideline for reporting systematic reviews BMJ 2021 372 n71 10.1136/bmj.n71 33782057
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.33782057 10.1136/bmj.n71
10. Saltzman C New FAI guidelines: STROBE, MOOSE, PRISMA, CONSORT Foot Ankle Int 2022 43 1 1 10.1177/10711007211063029 35023395
Saltzman C. New FAI guidelines: STROBE, MOOSE, PRISMA, CONSORT. Foot Ankle Int. 2022;43(1):1.35023395 10.1177/10711007211063029
11. Rostom A, Dubé C, Cranney A, Saloojee N, Sy R, Garritty C, Sampson M, Zhang L, Yazdi F, Mamaladze V et al. Celiac disease. Evid Rep Technol Assess (Summ) 2004(104):1–6.
12. Stang A Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses Eur J Epidemiol 2010 25 9 603 5 10.1007/s10654-010-9491-z 20652370
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.20652370 10.1007/s10654-010-9491-z
13. Makizako H Shimada H Tsutsumimoto K Lee S Doi T Nakakubo S Hotta R Suzuki T Social Frailty in Community-Dwelling older adults as a risk factor for disability J Am Med Dir Assoc 2015 16 11 e10031007 1011 10.1016/j.jamda.2015.08.023
Makizako H, Shimada H, Tsutsumimoto K, Lee S, Doi T, Nakakubo S, Hotta R, Suzuki T. Social Frailty in Community-Dwelling older adults as a risk factor for disability. J Am Med Dir Assoc. 2015;16(11):e10031007–1011.10.1016/j.jamda.2015.08.023
14. Tsutsumimoto K Doi T Makizako H Hotta R Nakakubo S Makino K Suzuki T Shimada H Association of Social Frailty with both cognitive and physical deficits among older people J Am Med Dir Assoc 2017 18 7 603 7 10.1016/j.jamda.2017.02.004 28411094
Tsutsumimoto K, Doi T, Makizako H, Hotta R, Nakakubo S, Makino K, Suzuki T, Shimada H. Association of Social Frailty with both cognitive and physical deficits among older people. J Am Med Dir Assoc. 2017;18(7):603–7.28411094 10.1016/j.jamda.2017.02.004
15. Ma L Sun F Tang Z Social Frailty is Associated with Physical Functioning, Cognition, and Depression, and predicts mortality J Nutr Health Aging 2018 22 8 989 95 10.1007/s12603-018-1054-0 30272104
Ma L, Sun F, Tang Z. Social Frailty is Associated with Physical Functioning, Cognition, and Depression, and predicts mortality. J Nutr Health Aging. 2018;22(8):989–95.30272104 10.1007/s12603-018-1054-0
16. Makizako H Shimada H Doi T Tsutsumimoto K Hotta R Nakakubo S Makino K Lee S Social Frailty leads to the development of physical Frailty among physically non-frail adults: a Four-Year Follow-Up longitudinal cohort study Int J Environ Res Public Health 2018 15 3 1660 4601 10.3390/ijerph15030490 30081597
Makizako H, Shimada H, Doi T, Tsutsumimoto K, Hotta R, Nakakubo S, Makino K, Lee S. Social Frailty leads to the development of physical Frailty among physically non-frail adults: a Four-Year Follow-Up longitudinal cohort study. Int J Environ Res Public Health. 2018;15(3):1660–4601.30081597 10.3390/ijerph15030490
17. Rietman ML. a DL, van Oostrom SH, Picavet HSJ, Dollé MET, van Steeg H, Verschuren WMM, Spijkerman AMW: The Association Between BMI and Different Frailty Domains: A U-Shaped Curve? Journal of Nutrition, Health and Aging 2018, 22(1):8–15.
18. Teo N Gao Q Nyunt MSZ Wee SL Ng TP Social Frailty and functional disability: findings from the Singapore Longitudinal Ageing Study I (SLAS-I) Australas J Ageing 2018 7 18 e13 637
Teo N, Gao Q, Nyunt MSZ, Wee SL, Ng TP. Social Frailty and functional disability: findings from the Singapore Longitudinal Ageing Study I (SLAS-I). Australas J Ageing. 2018;7(18):e13–637.
19. Tsutsumimoto K Doi T Makizako H Hotta R Nakakubo S Kim M Kurita S Suzuki T Shimada H Social Frailty has a stronger impact on the onset of depressive symptoms than physical frailty or cognitive impairment: a 4-Year follow-up Longitudinal Cohort Study J Am Med Dir Assoc 2018 19 6 504 10 10.1016/j.jamda.2018.02.008 29703687
Tsutsumimoto K, Doi T, Makizako H, Hotta R, Nakakubo S, Kim M, Kurita S, Suzuki T, Shimada H. Social Frailty has a stronger impact on the onset of depressive symptoms than physical frailty or cognitive impairment: a 4-Year follow-up Longitudinal Cohort Study. J Am Med Dir Assoc. 2018;19(6):504–10.29703687 10.1016/j.jamda.2018.02.008
20. Yamada M Arai H Social Frailty Predicts Incident Disability and Mortality among Community-Dwelling Japanese older adults J Am Med Dir Assoc 2018 19 12 1099 103 10.1016/j.jamda.2018.09.013 30471801
Yamada M, Arai H. Social Frailty Predicts Incident Disability and Mortality among Community-Dwelling Japanese older adults. J Am Med Dir Assoc. 2018;19(12):1099–103.30471801 10.1016/j.jamda.2018.09.013
21. Hirase T Makizako H Okubo Y Lord SR Inokuchi S Okita M Chronic pain is independently associated with social frailty in community-dwelling older adults Geriatr Gerontol Int 2019 19 11 1153 6 10.1111/ggi.13785 31646711
Hirase T, Makizako H, Okubo Y, Lord SR, Inokuchi S, Okita M. Chronic pain is independently associated with social frailty in community-dwelling older adults. Geriatr Gerontol Int. 2019;19(11):1153–6.31646711 10.1111/ggi.13785
22. Jang I Park H Jung H Lee Y Lee E Kim D Prevalence of social frailty and its association with physical frailty and disability in community-dwelling older adults: aging study of Pyeongchang rural area J Am Geriatr Soc 2019 67 S128
Jang I, Park H, Jung H, Lee Y, Lee E, Kim D. Prevalence of social frailty and its association with physical frailty and disability in community-dwelling older adults: aging study of Pyeongchang rural area. J Am Geriatr Soc. 2019;67:S128.
23. Makizako H Kubozono T Kiyama R Takenaka T Kuwahata S Tabira T Kanoya T Horinouchi K Shimada H Ohishi M Associations of social frailty with loss of muscle mass and muscle weakness among community-dwelling older adults Geriatr Gerontol Int 2019 19 1 76 80 10.1111/ggi.13571 30575241
Makizako H, Kubozono T, Kiyama R, Takenaka T, Kuwahata S, Tabira T, Kanoya T, Horinouchi K, Shimada H, Ohishi M. Associations of social frailty with loss of muscle mass and muscle weakness among community-dwelling older adults. Geriatr Gerontol Int. 2019;19(1):76–80.30575241 10.1111/ggi.13571
24. Nakakubo S Doi T Makizako H Tsutsumimoto K Kurita S Kim M Ishii H Suzuki T Shimada H Association of sleep condition and social frailty in community-dwelling older people Geriatr Gerontol Int 2019 19 9 885 9 10.1111/ggi.13734 31321900
Nakakubo S, Doi T, Makizako H, Tsutsumimoto K, Kurita S, Kim M, Ishii H, Suzuki T, Shimada H. Association of sleep condition and social frailty in community-dwelling older people. Geriatr Gerontol Int. 2019;19(9):885–9.31321900 10.1111/ggi.13734
25. Park H Jang IY Lee HY Jung HW Lee E Kim DH Screening Value of Social Frailty and Its Association with Physical Frailty and Disability in Community-Dwelling older koreans: Aging Study of PyeongChang Rural Area Int J Environ Res Public Health 2019 16 16 2809 10.3390/ijerph16162809 31394719
Park H, Jang IY, Lee HY, Jung HW, Lee E, Kim DH. Screening Value of Social Frailty and Its Association with Physical Frailty and Disability in Community-Dwelling older koreans: Aging Study of PyeongChang Rural Area. Int J Environ Res Public Health. 2019;16(16):2809.31394719 10.3390/ijerph16162809
26. Tsutsumimoto K Doi T Nakakubo S Kim M Kurita S Ishii H Shimada H Kawachi I Impact of Social Frailty on Alzheimer’s Disease Onset: a 53-Month Longitudinal Cohort Study J Alzheimer’s Disease: JAD 2019 70 2 587 95 10.3233/JAD-181178 31256123
Tsutsumimoto K, Doi T, Nakakubo S, Kim M, Kurita S, Ishii H, Shimada H, Kawachi I. Impact of Social Frailty on Alzheimer’s Disease Onset: a 53-Month Longitudinal Cohort Study. J Alzheimer’s Disease: JAD. 2019;70(2):587–95.31256123 10.3233/JAD-181178
27. Verver D Merten H de Blok C Wagner C A cross sectional study on the different domains of frailty for independent living older adults BMC Geriatr 2019 19 1 61 10.1186/s12877-019-1077-3 30823875
Verver D, Merten H, de Blok C, Wagner C. A cross sectional study on the different domains of frailty for independent living older adults. BMC Geriatr. 2019;19(1):61.30823875 10.1186/s12877-019-1077-3
28. Yoo M Kim S Kim BS Yoo J Lee S Jang HC Cho BL Son SJ Lee JH Park YS Moderate hearing loss is related with social frailty in a community-dwelling older adults: the Korean Frailty and Aging Cohort Study (KFACS) Arch Gerontol Geriatr 2019 83 126 30 10.1016/j.archger.2019.04.004 31003135
Yoo M, Kim S, Kim BS, Yoo J, Lee S, Jang HC, Cho BL, Son SJ, Lee JH, Park YS, et al. Moderate hearing loss is related with social frailty in a community-dwelling older adults: the Korean Frailty and Aging Cohort Study (KFACS). Arch Gerontol Geriatr. 2019;83:126–30.31003135 10.1016/j.archger.2019.04.004
29. Zhang X Tan SS Franse CB Alhambra-Borrás T Durá-Ferrandis E Bilajac L Markaki A Verma A Mattace-Raso F Voorham AJJ Association between physical, psychological and social frailty and health-related quality of life among older people Eur J Pub Health 2019 29 5 936 42 10.1093/eurpub/ckz099 31168603
Zhang X, Tan SS, Franse CB, Alhambra-Borrás T, Durá-Ferrandis E, Bilajac L, Markaki A, Verma A, Mattace-Raso F, Voorham AJJ, et al. Association between physical, psychological and social frailty and health-related quality of life among older people. Eur J Pub Health. 2019;29(5):936–42.31168603 10.1093/eurpub/ckz099
30. Hironaka S Kugimiya Y Watanabe Y Motokawa K Hirano H Kawai H Kera T Kojima M Fujiwara Y Ihara K Association between oral, social, and physical frailty in community-dwelling older adults Arch Gerontol Geriatr 2020 89 104 5 10.1016/j.archger.2020.104105
Hironaka S, Kugimiya Y, Watanabe Y, Motokawa K, Hirano H, Kawai H, Kera T, Kojima M, Fujiwara Y, Ihara K, et al. Association between oral, social, and physical frailty in community-dwelling older adults. Arch Gerontol Geriatr. 2020;89:104–5.10.1016/j.archger.2020.104105
31. Huang CH, Okada K, Matsushita E, Uno C, Satake S, Arakawa Martins B, Kuzuya M. Sex-specific association between Social Frailty and Diet Quality, Diet Quantity, and Nutrition in Community-Dwelling Elderly. Nutrients 2020, 12(9).
32. Pek K, Chew J, Lim JP, Yew S, Tan CN, Yeo A, Ding YY, Lim WS. Social Frailty is independently Associated with Mood, Nutrition, Physical Performance, and physical activity: insights from a theory-guided Approach. Int J Environ Res Public Health 2020, 17(12).
33. Zhang WY Fan JY Wang TY Li J Correlation between social frailty and depression in community elderly in Hubei Province Practical Gerontol 2021 35 05 491 4
Zhang WY, Fan JY, Wang TY, Li J. Correlation between social frailty and depression in community elderly in Hubei Province. Practical Gerontol. 2021;35(05):491–4.
34. Peng XY Zhang FSM Luo W Chen BB Social frailty of the elderly in community and its influencing factors Nurs Res 2021 35 19 3401 6
Peng XY, Zhang FSM, Luo W, Chen BB. Social frailty of the elderly in community and its influencing factors. Nurs Res. 2021;35(19):3401–6.
35. Chen ZK Jiang XY Shi GP Wang Y Chu XF Wang ZD Guo JH Zhu YS Chen J Wang XF Social Frailty and longitudinal risk of depressive symptoms in a Chinese population: the Rugao Longevity and Aging Study Psychogeriatrics: Official J Japanese Psychogeriatr Soc 2021 21 4 483 90 10.1111/psyg.12696
Chen ZK, Jiang XY, Shi GP, Wang Y, Chu XF, Wang ZD, Guo JH, Zhu YS, Chen J, Wang XF, et al. Social Frailty and longitudinal risk of depressive symptoms in a Chinese population: the Rugao Longevity and Aging Study. Psychogeriatrics: Official J Japanese Psychogeriatr Soc. 2021;21(4):483–90.10.1111/psyg.12696
36. Huang CH Okada K Matsushita E Uno C Satake S Martins BA Kuzuya M The association of social frailty with intrinsic capacity in community-dwelling older adults: a prospective cohort study BMC Geriatr 2021 21 1 515 10.1186/s12877-021-02466-6 34579661
Huang CH, Okada K, Matsushita E, Uno C, Satake S, Martins BA, Kuzuya M. The association of social frailty with intrinsic capacity in community-dwelling older adults: a prospective cohort study. BMC Geriatr. 2021;21(1):515.34579661 10.1186/s12877-021-02466-6
37. Ko H, Jung S. Association of Social Frailty with Physical Health, cognitive function, Psychological Health, and life satisfaction in Community-Dwelling Older koreans. Int J Environ Res Public Health 2021, 18(2).
38. Ono R Murata S Uchida K Endo T Otani K Reciprocal relationship between locomotive syndrome and social frailty in older adults Geriatr Gerontol Int 2021 21 11 981 4 10.1111/ggi.14273 34505337
Ono R, Murata S, Uchida K, Endo T, Otani K. Reciprocal relationship between locomotive syndrome and social frailty in older adults. Geriatr Gerontol Int. 2021;21(11):981–4.34505337 10.1111/ggi.14273
39. Song G Wang Y Gao HL Chen L Yang YL Correlation between sleep disorders and social frailty in elderly people in community Practical Gerontol 2022 36 08 813 7
Song G, Wang Y, Gao HL, Chen L, Yang YL. Correlation between sleep disorders and social frailty in elderly people in community. Practical Gerontol. 2022;36(08):813–7.
40. Liu H Lin X Social frailty of the elderly in a community of Changsha City and its influencing factors Occup Health 2022 38 14 1978 81
Liu H, Lin X. Social frailty of the elderly in a community of Changsha City and its influencing factors. Occup Health. 2022;38(14):1978–81.
41. Hao J FJ Investigation on social frailty of community elderly in Hubei Province and analysis of influencing factors Contemp Nurses 2022 29 09 88 93
Hao J, FJ. Investigation on social frailty of community elderly in Hubei Province and analysis of influencing factors. Contemp Nurses. 2022;29(09):88–93.
42. Chen YW Huang XH Pu YH Xu JX Relationship between social frailty and quality of life of elderly people in community Gerontol Health care 2022 28 01 30 4
Chen YW, Huang XH, Pu YH, Xu JX. Relationship between social frailty and quality of life of elderly people in community. Gerontol Health care. 2022;28(01):30–4.
43. Choi S, Ko H. Social Frailty among Community-Dwelling older adults during the COVID-19 pandemic in Korea: a cross-sectional study. Int J Environ Res Public Health 2022, 19(19).
44. Doi T Tsutsumimoto K Ishii H Nakakubo S Kurita S Kiuchi Y Nishimoto K Shimada H Impact of social frailty on the association between driving status and disability in older adults Arch Gerontol Geriatr 2022 99 104597 10.1016/j.archger.2021.104597 34942436
Doi T, Tsutsumimoto K, Ishii H, Nakakubo S, Kurita S, Kiuchi Y, Nishimoto K, Shimada H. Impact of social frailty on the association between driving status and disability in older adults. Arch Gerontol Geriatr. 2022;99:104597.34942436 10.1016/j.archger.2021.104597
45. Hayashi T Noguchi T Kubo Y Tomiyama N Ochi A Hayashi H Social Frailty and depressive symptoms during the COVID-19 pandemic among older adults in Japan: role of home exercise habits Arch Gerontol Geriatr 2022 98 104555 10.1016/j.archger.2021.104555 34700134
Hayashi T, Noguchi T, Kubo Y, Tomiyama N, Ochi A, Hayashi H. Social Frailty and depressive symptoms during the COVID-19 pandemic among older adults in Japan: role of home exercise habits. Arch Gerontol Geriatr. 2022;98:104555.34700134 10.1016/j.archger.2021.104555
46. Ko Y Lee K Social Frailty and Health-Related Quality of Life in Community-Dwelling older adults Int J Environ Res Public Health 2022 19 9 56 9 10.3390/ijerph19095659
Ko Y, Lee K. Social Frailty and Health-Related Quality of Life in Community-Dwelling older adults. Int J Environ Res Public Health. 2022;19(9):56–9.10.3390/ijerph19095659
47. Kodama A, Kume Y, Lee S, Makizako H, Shimada H, Takahashi T, Ono T, Ota H. Impact of COVID-19 pandemic exacerbation of depressive symptoms for Social Frailty from the ORANGE Registry. Int J Environ Res Public Health 2022, 19(2).
48. Kume Y Kodama A Takahashi T Lee S Makizako H Ono T Shimada H Ota H Social Frailty is independently associated with geriatric depression among older adults living in northern Japan: a cross-sectional study of ORANGE registry Geriatr Gerontol Int 2022 22 2 145 51 10.1111/ggi.14330 34935256
Kume Y, Kodama A, Takahashi T, Lee S, Makizako H, Ono T, Shimada H, Ota H. Social Frailty is independently associated with geriatric depression among older adults living in northern Japan: a cross-sectional study of ORANGE registry. Geriatr Gerontol Int. 2022;22(2):145–51.34935256 10.1111/ggi.14330
49. Miyata H, Maruta M, Makizako H, Han GH, Ikeda Y, Nakamura A, Tokuda K, Shimokihara S, Akaida S, Hidaka Y et al. Association between satisfaction with meaningful activities and social frailty in community-dwelling Japanese older adults. Arch Gerontol Geriatr 2022, 100.
50. Sugie M Harada K Nara M Kugimiya Y Takahashi T Kitagou M Kim H Kyo S Ito H Prevalence, overlap, and interrelationships of physical, cognitive, psychological, and social frailty among community-dwelling older people in Japan Arch Gerontol Geriatr 2022 100 104659 10.1016/j.archger.2022.104659 35190333
Sugie M, Harada K, Nara M, Kugimiya Y, Takahashi T, Kitagou M, Kim H, Kyo S, Ito H. Prevalence, overlap, and interrelationships of physical, cognitive, psychological, and social frailty among community-dwelling older people in Japan. Arch Gerontol Geriatr. 2022;100:104659.35190333 10.1016/j.archger.2022.104659
51. Ferreira LD Araújo MD Tavares DMD Bolina AF Quality of life and social vulnerability of older adults in the urban community: a cross-sectional study Geriatr Nurs 2022 46 46 51 10.1016/j.gerinurse.2022.04.026 35605550
Ferreira LD, Araújo MD, Tavares DMD, Bolina AF. Quality of life and social vulnerability of older adults in the urban community: a cross-sectional study. Geriatr Nurs. 2022;46:46–51.35605550 10.1016/j.gerinurse.2022.04.026
52. Ragusa FS Veronese N Smith L Koyanagi A Dominguez LJ Barbagallo M Social Frailty increases the risk of all-cause mortality: a longitudinal analysis of the English Longitudinal Study of Ageing Exp Gerontol 2022 167 111901 10.1016/j.exger.2022.111901 35870753
Ragusa FS, Veronese N, Smith L, Koyanagi A, Dominguez LJ, Barbagallo M. Social Frailty increases the risk of all-cause mortality: a longitudinal analysis of the English Longitudinal Study of Ageing. Exp Gerontol. 2022;167:111901.35870753 10.1016/j.exger.2022.111901
53. Yang QJ, Xin XL, Zhang MM, Zhang L, Peng DM. Analysis of social weakness status quo and influencing factors of rural empty-nest elderly in Chengde City. Chinese Science and Technology Journal Database (full text) Social Sciences 2023(8).
54. Chen IC Chang SH The relationship between coronavirus-related anxiety on physical frailty, psychological frailty, and social frailty in older community- dwellers in Taiwan during the COVID-19 pandemic J Health Res 2023 37 4 253 60 10.56808/2586-940X.1041
Chen IC, Chang SH. The relationship between coronavirus-related anxiety on physical frailty, psychological frailty, and social frailty in older community- dwellers in Taiwan during the COVID-19 pandemic. J Health Res. 2023;37(4):253–60.10.56808/2586-940X.1041
55. Jeong HN Chang SJ Association between Social Frailty and life satisfaction among older adults: the Role of Functional limitations and depressive symptoms Res Gerontol Nurs 2023 16 6 291 300 10.3928/19404921-20230817-02 37616480
Jeong HN, Chang SJ. Association between Social Frailty and life satisfaction among older adults: the Role of Functional limitations and depressive symptoms. Res Gerontol Nurs. 2023;16(6):291–300.37616480 10.3928/19404921-20230817-02
56. Qi X Li YY Hu JB Meng LB Zeng P Shi J Jia N Zeng XZ Li H Zhang QX Prevalence of social frailty and its associated factors in the older Chinese population: a national cross-sectional study BMC Geriatr 2023 23 1 532 10.1186/s12877-023-04241-1 37658332
Qi X, Li YY, Hu JB, Meng LB, Zeng P, Shi J, Jia N, Zeng XZ, Li H, Zhang QX, et al. Prevalence of social frailty and its associated factors in the older Chinese population: a national cross-sectional study. BMC Geriatr. 2023;23(1):532.37658332 10.1186/s12877-023-04241-1
57. Sun QQ Tan K Tang HY Liu YY Zhu H Qin H Xia X Zhang M Chen YY Nie SS Incidence and predictive value of social frailty among community-dwelling older adults in Southwest China: a prospective cohort study Front Public Health 2023 11 1103651 10.3389/fpubh.2023.1103651 36891342
Sun QQ, Tan K, Tang HY, Liu YY, Zhu H, Qin H, Xia X, Zhang M, Chen YY, Nie SS, et al. Incidence and predictive value of social frailty among community-dwelling older adults in Southwest China: a prospective cohort study. Front Public Health. 2023;11:1103651.36891342 10.3389/fpubh.2023.1103651
58. Yamada M Arai H Understanding social frailty Arch Gerontol Geriatr 2023 115 105 23 10.1016/j.archger.2023.105123
Yamada M, Arai H. Understanding social frailty. Arch Gerontol Geriatr. 2023;115:105–23.10.1016/j.archger.2023.105123
59. Collard RM Boter H Schoevers RA Oude Voshaar RC Prevalence of frailty in community-dwelling older persons: a systematic review J Am Geriatr Soc 2012 60 8 1487 92 10.1111/j.1532-5415.2012.04054.x 22881367
Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60(8):1487–92.22881367 10.1111/j.1532-5415.2012.04054.x
60. Qiu Y Li G Wang X Zheng L Wang C Wang C Chen L Prevalence of cognitive frailty among community-dwelling older adults: a systematic review and meta-analysis Int J Nurs Stud 2022 125 104 12 10.1016/j.ijnurstu.2021.104112
Qiu Y, Li G, Wang X, Zheng L, Wang C, Wang C, Chen L. Prevalence of cognitive frailty among community-dwelling older adults: a systematic review and meta-analysis. Int J Nurs Stud. 2022;125:104–12.10.1016/j.ijnurstu.2021.104112
61. Collaborators GFF. 1950–2021, with forecasts to 2100: a comprehensive demographic analysis for the global burden of Disease Study 2021. Global fertility in 204 countries and territories. Lancet; 2024.
62. Hamid TA Salih SA Zillah Abdullah SF Ibrahim R Mahmud A Characterization of social frailty domains and related adverse health outcomes in the Asia-Pacific: a systematic literature review PeerJ 2024 12 e17058 10.7717/peerj.17058 38500524
Hamid TA, Salih SA, Zillah Abdullah SF, Ibrahim R, Mahmud A. Characterization of social frailty domains and related adverse health outcomes in the Asia-Pacific: a systematic literature review. PeerJ. 2024;12:e17058.38500524 10.7717/peerj.17058
63. Qi X Li J The relationship between Social Frailty and depressive symptoms in the Elderly: a scoping review Int J Environ Res Public Health 2022 19 24 166 83 10.3390/ijerph192416683
Qi X, Li J. The relationship between Social Frailty and depressive symptoms in the Elderly: a scoping review. Int J Environ Res Public Health. 2022;19(24):166–83.10.3390/ijerph192416683
64. Toros T Ogras EB Toy AB Kulak A Esen HT Ozer SC Celik T The impact of regular Exercise on life satisfaction, Self-Esteem, and self-efficacy in older adults Behav Sci (Basel Switzerland) 2023 13 9 714
Toros T, Ogras EB, Toy AB, Kulak A, Esen HT, Ozer SC, Celik T. The impact of regular Exercise on life satisfaction, Self-Esteem, and self-efficacy in older adults. Behav Sci (Basel Switzerland). 2023;13(9):714.
65. Ma W Wu B Gao X Zhong R Association between frailty and cognitive function in older Chinese people: a moderated mediation of social relationships and depressive symptoms J Affect Disord 2022 316 223 32 10.1016/j.jad.2022.08.032 35988782
Ma W, Wu B, Gao X, Zhong R. Association between frailty and cognitive function in older Chinese people: a moderated mediation of social relationships and depressive symptoms. J Affect Disord. 2022;316:223–32.35988782 10.1016/j.jad.2022.08.032
66. Bassuk SS Glass TA Berkman LF Social disengagement and incident cognitive decline in community-dwelling elderly persons Ann Intern Med 1999 131 3 165 73 10.7326/0003-4819-131-3-199908030-00002 10428732
Bassuk SS, Glass TA, Berkman LF. Social disengagement and incident cognitive decline in community-dwelling elderly persons. Ann Intern Med. 1999;131(3):165–73.10428732 10.7326/0003-4819-131-3-199908030-00002
67. Nagai K Tamaki K Kusunoki H Wada Y Tsuji S Itoh M Sano K Amano M Hayashitani S Yokoyama R Physical frailty predicts the development of social frailty: a prospective cohort study BMC Geriatr 2020 20 1 403 10.1186/s12877-020-01814-2 33054731
Nagai K, Tamaki K, Kusunoki H, Wada Y, Tsuji S, Itoh M, Sano K, Amano M, Hayashitani S, Yokoyama R, et al. Physical frailty predicts the development of social frailty: a prospective cohort study. BMC Geriatr. 2020;20(1):403.33054731 10.1186/s12877-020-01814-2
68. Li X Gao L Qiu Y Zhong T Zheng L Liu W Li G Chen L Social Frailty as a predictor of adverse outcomes among older adults: a systematic review and meta-analysis Aging Clin Exp Res 2023 35 7 1417 28 10.1007/s40520-023-02421-y 37219756
Li X, Gao L, Qiu Y, Zhong T, Zheng L, Liu W, Li G, Chen L. Social Frailty as a predictor of adverse outcomes among older adults: a systematic review and meta-analysis. Aging Clin Exp Res. 2023;35(7):1417–28.37219756 10.1007/s40520-023-02421-y
