The role of frailty in the relationships between social relationships and health outcomes: a longitudinal study.

BACKGROUND: Socially isolated older adults incur increased risks of adverse health outcomes, though the strength of this association is unclear. We examined whether changes in physical frailty moderated the associations between changes in social relationships and changes in health outcomes among older adults. METHODS: This longitudinal study is based on three waves of the FRéLE study among 1643 Canadian community-dwelling older adults aged 65 years and older over 2 years. We performed latent growth curve modelling (LGMs) to assess changes with the assumption of missing not at random, adjusting for time-invariant covariates. We used the latent moderated structural equations (LMS) to test the interactions in LGMs. Social relationships were measured by social participation, social networks, and social support from different social ties. Frailty was assessed using the five components of the phenotype of frailty. RESULTS: The results revealed that changes in frailty moderated changes in social participation (ß = 3.229, 95% CI: 2.212, 4.245), social contact with friends (ß = 4.980, 95% CI: 3.285, 6.675), and social support from friends (ß = 2.406, 95% CI: 1.894, 2.917), children (ß = 2.957, 95% CI: 1.932, 3.982), partner (ß = 4.170, 95% CI: 3.036, 5.305) and extended family (ß = 6.619, 95% CI: 2.309, 10.923) with changes in cognitive function and depressive symptoms, but not with chronic diseases. These results highlight the beneficial role of social relationships in declining depressive symptoms and improving cognitive health among older adults experiencing increases in frailty. CONCLUSIONS: The findings suggest that changes in social support have a protective and compensatory role in decreasing depressive symptoms and enhancing cognitive health among older adults with increasing frailty. Public health policy and strategies should consider the impact of social support on multiple health outcomes among older adults with increasing frailty. Further experimental studies and interventions are warranted to extend findings on the relationships between social relationships and health outcomes, targeting frail older adults. Future studies may also consider other health-related risk factors that may impact the associations between social relationships and health outcomes among older adults.

The Potential of Social Policies in Preventing Dementia: An Ecological Study Using Systematic Review and Meta-Analysis.

Social policies determine the distribution of factors (e.g. education, cardiovascular health) protecting against the development of dementia in Alzheimer's disease (AD). However, the association between social policies and the likelihood of AD without dementia (ADw/oD) has yet to be evaluated. We estimated this association in an ecological study using systematic review and meta-analysis. Four reference databases were consulted; 18 studies were included in the final analysis. ADw/oD was defined as death without dementia in people with clinically significant AD brain pathology. The indicators of social policy were extracted from the Organisation for Economic Co-operation and Development database (OECD). The probability of ADw/oD with moderate AD brain pathology was inversely associated with the Gini index for disposable income, poverty rate, and certain public expenditures on healthcare. ADw/oD with advanced AD brain pathology was only associated with public expenditures for long-term care. Social policies may play a role in maintaining and sustaining cognitive health among older people with AD.

Frailty as a Moderator of the Relationship between Social Isolation and Health Outcomes in Community-Dwelling Older Adults.

This research investigated the effects of social isolation on frailty and health outcomes and tested whether these associations varied across different levels of frailty. We performed a multivariate analysis of the first wave of Frailty: A longitudinal study of its expressions (FRéLE) among 1643 Canadian older adults aged 65 years and over. We assessed social isolation using social participation, social networks, and support from various social ties, namely, friends, children, extended family, and partner. Frailty was associated with disability, comorbidity, depression, and cognitive decline. Less social participation was associated with limitations in instrumental activities of daily living (IADLs), depression, and cognitive decline. The absence of friends was associated with depression and cognitive impairment. Less social support from children and partner was related to comorbidity, depression, and cognitive decline. Overall, social isolation is linked to mental health rather than physical health. The associations of having no siblings, receiving less support from friends, and participating less in social activities with ADL limitations, depression, and cognitive decline were higher among frail than prefrail and robust older adults. This study corroborates the pivotal role of social connectedness, particularly the quality of relationships, on the mental health of older adults. Public health policies on social relationships are paramount to ameliorate the health status of frail older adults.

Pro-equity legislation, health policy and utilisation of sexual and reproductive health services by vulnerable populations in sub-Saharan Africa: a systematic review.

Twenty-five years ago, the International Conference on Population and Development highlighted the need to address sexual and reproductive health (SRH) rights on a global scale. The sub-Saharan Africa region continues to have the highest levels of maternal mortality and HIV, primarily affecting the most vulnerable populations. Recognising the critical role of policy in understanding population health, we conducted a systematic review of original primary research which examined the relationships between equity-focused legislation and policy and the utilisation of SRH services by vulnerable populations in sub-Saharan Africa. We searched nine bibliographic databases for relevant articles published between 1994 and 2019. Thirty-two studies, conducted in 14 sub-Saharan African countries, met the inclusion criteria. They focused on maternal health service utilisation, either through specific fee reduction/removal policies, or through healthcare reforms and insurance schemes to increase SRH service utilisation. Findings across most of the studies showed that health-related legislation and policy promoted an increase in service utilisation, over time, especially for antenatal care, skilled birth attendance and facility-based delivery. However, social health inequalities persisted among subgroups of women. Neither the reviewed studies nor the policies specifically addressed youth, people living with HIV and people with disabilities. In the era of the sustainable development goals, addressing health inequities in the context of social determinants of health becomes unavoidable. Systematic and rigorous quantitative and qualitative research, including longitudinal policy evaluation, is required to understand the complex relationships between policy addressing upstream social determinants of health and health service utilisation.

Effects of social isolation, loneliness and frailty on health outcomes and their possible mediators and moderators in community-dwelling older adults: A scoping review.

BACKGROUND/OBJECTIVES: Over the past decade, the quantity and quality of social relationships in later life have become one of the main challenges facing an aging society. Our aims were to map and synthesize the literature addressing the effects of loneliness, three aspects of social isolation, including social networks, social support, and social participation, and frailty on health outcomes and their mediators and moderators among older adults. METHODS: We conducted a scoping review and searched for articles published in English and French from 2001 up to 2019 in the following databases: Medline, Embase, CINAHL Plus, Scopus, Web of Science and PsycINFO. RESULTS: Our database search initially resulted in 4001 articles of which 1832 were excluded; 26 were eligible. Most of the included studies revealed associations between social isolation, loneliness and frailty. The majority of studies found evidence of associations between frailty and their adverse outcomes; however, only few studies found a relationship between social isolation and health outcomes. In spite of the established link between frailty and adverse outcomes, no study looked at how social isolation and loneliness can alter adverse outcomes of frailty. No study investigated the role of frailty or social isolation and loneliness as a mediator on the pathway related to health. CONCLUSIONS: Evidence is limited in examining the role of frailty or social isolation and loneliness as a moderator and mediator. Longitudinal research combining both social isolation and loneliness are warranted to explore whether social isolation or loneliness has more deleterious effects on frailty and health outcomes.