Post-Pandemic Impact: How Screening for Social Frailty Might Save a Life

By Kyung-eun (Lilly) Park, PT, DPT
Outreach Physical Therapist

As we surpass two years since the onset of the COVID-19 pandemic, we are faced with issues resulting from the very strategy that helped to save lives: social isolation. Many older adults who have gone through great lengths to protect themselves from illness and mortality are battling the same consequences through a different diagnosis, social frailty.

Frailty is a geriatric syndrome characterized by a decreased reserve or resiliency to combat stressors. It is strongly predictive of falls, increased dependency, institutionalization and mortality. Social frailty, a phenotype of frailty, has received special attention due to its rising prevalence. It is defined as the loss of resources that are important for social fulfillment. Domains of social frailty include social needs (social and emotional support, loneliness), resources (income, food, housing, medical care) and self-management (cognitive function, mental health). Without social fulfillment, there is a high risk of physical frailty for older adults.

An insightful yet unnerving study by Falvey and colleagues explored the association between social isolation and poor functional outcomes and mortality. They analyzed data from Medicare beneficiaries admitted to the Intensive Care Unit (ICU) from 2011 to 2017, then interviewed the subjects one year later. Results showed that post-ICU disability was 7% higher with a rise of each point in the social isolation score. Compared to those who were the most socially integrated, those with moderate social isolation had 23% higher disability burden, and those with the greatest social isolation had 50%. Researchers also found increasing social isolation to be associated with higher risk of death within one year of hospital admission. Given these statistics, it would be worthwhile to screen older adults for their level of social isolation.

As in-home therapists, we are in a unique position to screen for social frailty, engage in early intervention, and manage the condition in order to prevent more costly or debilitating consequences. Although clinical tools to identify social frailty remain elusive for now, questions that target the core domains such as “do you have anyone you can contact in case of an emergency?” or “who will be accompanying you to the doctor’s office?” can provide insight into social frailty. If physical limitations exist, a program with range of motion, strengthening, and endurance goals could create the ability for social connection. We can also assist in providing community resources to encourage healthier social habits. Interventions such as a 10 minute outdoor gait training, while greeting neighbors, could be impactful. We must proceed with a positive outlook that poor health is not inevitable; the change can start in your therapy session.