OP66 Effects of social engagement and loneliness on the progression and reversion of frailty: longitudinal investigations of two prospective cohorts from the UK and the USA

Background

With a rapidly expanding ageing population, frailty has become a public health challenge. Social connections, including quantitative (i.e., the number of social engagements) and qualitative aspects (i.e. loneliness), have been theorised to contribute to frailty. Few studies have untangled their effects on the dynamic trajectory of frailty, including, development and reversal across pre-frailty and frailty stages. This study investigated whether baseline, and change in, social engagement and loneliness affect the progression and reversal of frailty in older adults using two prospective studies.

Methods

We undertook a prospective analysis of two cohorts of older adults; the British Regional Heart Study (BRHS) in the UK (n=715) followed-up for eight years, and the US Health, Ageing and Body Composition (HABC) Study (N=1256) followed-up for four years. Multinominal regression models examined the effects of baseline and change in social engagement and loneliness on progression to pre-frailty and to frailty, as well as their effects on reversal to pre-frailty and robust (absence of frailty and pre-frailty) status. Covariates (sociodemographic, behavioural and health-related factors) were adjusted for in the models.

Results

In the BRHS and in the HABC Study, 36 and 22% of participants, respectively, progressed to pre-frailty/frailty; 12% in the BRHS and 14% in the HABC Study reversed from frailty to pre-frail/robust. In the analysis examining progression to frailty, results showed that a high level of social engagement at baseline (BRHS: relative risk ratio (RRR) 0.67 [95%CI=0.54–0.83]; HABC Study: RRR=0.56 [95%CI=0.45–0.70]), as well as increase in social engagement (BRHS: RRR=0.72, [95%CI=0.58–0.89]; HABC: RRR=0.51 [95%CI=0.41–0.63]), were significantly associated with a lower risk of developing frailty. A higher level of loneliness at baseline (BRHS: RRR=1.41 [95%CI=1.10–1.82]) and an increase in loneliness (RRR=1.11 [95%CI=1.15–1.84]) increased the risk of developing frailty. Examining the reversal of frailty, higher social engagement at baseline (HABC: RRR=1.63 [95%CI=1.08–1.19]) and an increase in social engagement (BRHS: RRR=1.74 [95%CI=1.20–2.53]; HABC: RRR=1.81[95%CI=1.19–2.75]) were beneficial in reversal of frailty status (frail to pre-frail/robust or pre-frail to robust). Adverse effects of loneliness on preventing the reversal of frailty were also observed in the BRHS cohort.

Conclusion

Social connections are potentially important and modifiable factors in both preventing, and reversing, frailty progression. Increasing social engagement and a sense of belonging could promote healthy ageing. Larger population-based studies, particularly with greater representation from ethnic minorities and women, are needed to further understand these associations in diverse populations of older adults.