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Social Vulnerability, Frailty and Mortality in Elderly People

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  • Melissa K Andrew
  • Arnold B Mitnitski
  • Kenneth Rockwood

Abstract

Background: Social vulnerability is related to the health of elderly people, but its measurement and relationship to frailty are controversial. The aims of the present study were to operationalize social vulnerability according to a deficit accumulation approach, to compare social vulnerability and frailty, and to study social vulnerability in relation to mortality. Methods and Findings: This is a secondary analysis of community-dwelling elderly people in two cohort studies, the Canadian Study of Health and Aging (CSHA, 1996/7–2001/2; N = 3707) and the National Population Health Survey (NPHS, 1994–2002; N = 2648). Social vulnerability index measures that used self-reported items (23 in NPHS, 40 in CSHA) were constructed. Each measure ranges from 0 (no vulnerability) to 1 (maximum vulnerability). The primary outcome measure was mortality over five (CHSA) or eight (NPHS) years. Associations with age, sex, and frailty (as measured by an analogously constructed frailty index) were also studied. All individuals had some degree of social vulnerability. Women had higher social vulnerability than men, and vulnerability increased with age. Frailty and social vulnerability were moderately correlated. Adjusting for age, sex, and frailty, each additional social ‘deficit’ was associated with an increased odds of mortality (5 years in CSHA, odds ratio = 1.05, 95% confidence interval: 1.02–1.07; 8 years in the NPHS, odds ratio = 1.08, 95% confidence interval: 1.03–1.14). We identified a meaningful survival gradient across quartiles of social vulnerability, and although women had better survival than men, survival for women with high social vulnerability was equivalent to that of men with low vulnerability. Conclusions: Social vulnerability is reproducibly related to individual frailty/fitness, but distinct from it. Greater social vulnerability is associated with mortality in older adults. Further study on the measurement and operationalization of social vulnerability, and of its relationships to other important health outcomes, is warranted.

Suggested Citation

  • Melissa K Andrew & Arnold B Mitnitski & Kenneth Rockwood, 2008. "Social Vulnerability, Frailty and Mortality in Elderly People," PLOS ONE, Public Library of Science, vol. 3(5), pages 1-8, May.
    • Handle: RePEc:plo:pone00:0002232
    DOI: 10.1371/journal.pone.0002232
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    6. Oleksandr Didkovskyi & Giovanni Azzone & Alessandra Menafoglio & Piercesare Secchi, 2021. "Social and material vulnerability in the face of seismic hazard: An analysis of the Italian case," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 184(4), pages 1549-1577, October.
    7. Sirio Cividino & Gianluca Egidi & Luca Salvati, 2020. "Unraveling the (Uneven) Linkage? A Reflection on Population Aging and Suburbanization in a Mediterranean Perspective," Sustainability, MDPI, vol. 12(11), pages 1-14, June.
    8. Maria Gabriella Melchiorre & Carlos Chiatti & Giovanni Lamura & Francisco Torres-Gonzales & Mindaugas Stankunas & Jutta Lindert & Elisabeth Ioannidi-Kapolou & Henrique Barros & Gloria Macassa & Joaqui, 2013. "Social Support, Socio-Economic Status, Health and Abuse among Older People in Seven European Countries," PLOS ONE, Public Library of Science, vol. 8(1), pages 1-10, January.
    9. Margie E Lachman & Stefan Agrigoroaei, 2010. "Promoting Functional Health in Midlife and Old Age: Long-Term Protective Effects of Control Beliefs, Social Support, and Physical Exercise," PLOS ONE, Public Library of Science, vol. 5(10), pages 1-9, October.
    10. Giulia Cavrini & Marina Marino & Agostino Stavolo, 2023. "The narrative of the social frailty of the older population in the Italian press," RIEDS - Rivista Italiana di Economia, Demografia e Statistica - The Italian Journal of Economic, Demographic and Statistical Studies, SIEDS Societa' Italiana di Economia Demografia e Statistica, vol. 77(3), pages 104-115, July-Sept.
    11. Silvana Miceli & Laura Maniscalco & Domenica Matranga, 2019. "Social networks and social activities promote cognitive functioning in both concurrent and prospective time: evidence from the SHARE survey," European Journal of Ageing, Springer, vol. 16(2), pages 145-154, June.
    12. Alexander Fekete, 2019. "Social vulnerability change assessment: monitoring longitudinal demographic indicators of disaster risk in Germany from 2005 to 2015," Natural Hazards: Journal of the International Society for the Prevention and Mitigation of Natural Hazards, Springer;International Society for the Prevention and Mitigation of Natural Hazards, vol. 95(3), pages 585-614, February.
    13. Shu-Yu Lin & Wei-Ju Lee & Ming-Yueh Chou & Li-Ning Peng & Shu-Ti Chiou & Liang-Kung Chen, 2016. "Frailty Index Predicts All-Cause Mortality for Middle-Aged and Older Taiwanese: Implications for Active-Aging Programs," PLOS ONE, Public Library of Science, vol. 11(8), pages 1-13, August.
    14. Tu N. Nguyen & Patrice Ngangue & Tarek Bouhali & Bridget L. Ryan & Moira Stewart & Martin Fortin, 2019. "Social Vulnerability in Patients with Multimorbidity: A Cross-Sectional Analysis," IJERPH, MDPI, vol. 16(7), pages 1-9, April.
    15. Khaksar, Seyed Mohammad Sadegh & Khosla, Rajiv & Chu, Mei Tai & Shahmehr, Fatemeh S., 2016. "Service Innovation Using Social Robot to Reduce Social Vulnerability among Older People in Residential Care Facilities," Technological Forecasting and Social Change, Elsevier, vol. 113(PB), pages 438-453.
    16. Yang Zhou & Ning Li & Wenxiang Wu & Jidong Wu & Peijun Shi, 2014. "Local Spatial and Temporal Factors Influencing Population and Societal Vulnerability to Natural Disasters," Risk Analysis, John Wiley & Sons, vol. 34(4), pages 614-639, April.
    17. Jaekyung Lee & Saheum Hong & Yunmi Park, 2017. "Predictable Surprise: The Spatial and Social Morphology of Aging Suburbs in the U.S. Metropolitan Areas," Sustainability, MDPI, vol. 9(3), pages 1-20, March.

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