1. Social Isolation, Frailty and Health outcomes in Community-
Dwelling Older Adults: A Scoping Review
Fereshteh Mehrabi 1,2, François Béland 1,2,3
1 School of Public Health (ESPUM), University of Montreal
2 Research Institute of Public Health of the University of Montreal (IRSPUM)
3 SOLIDAGE the McGill University-University of Montreal Research Group on Frailty and Aging
Direction des affaires internationales
2. Objective
1
To identify the relationship
between social isolation,
frailty and health
outcomes in community
dwelling older adults
3. Social Isolation
Objective Subjective
50% of older
adults are isolated
Quantity of relationships Quality of relationships
Berkman and Kirshna 2014
2
Social Networks Social Participation Social Support Loneliness
4. Frailty is defined as a state of increased vulnerability resulting from age-associated
decline in reserve and function across multiple physiological systems which leads to
poor health outcomes.
Physical Frailty
disability
comorbidityFrailty
Fried et al., 2001
Frailty
Slowness
Weight
loss
Exhaustion
Low
physical
activity
Weakness
3
5. The relationships between social isolation, frailty and health based
on three models
Model 1
Health
Outcomes
Social
Isolation
Frailty
Model 2a
Mediation
Social
Isolation
Health
Outcomes
Frailty
Social
Isolation
Health
OutcomesFrailty
Model 2b
Mediation
4
7. Arksey & O‘Malley’s Methodological Framework
1
Research
Questions
2
Relevant
Studies
3
Select
Studies
4
Chart Data
5
Collate,
Summarize
Report
What evidence exists in the relationship
between social isolation and frailty?
What evidence exists in the relationship
between social isolation, frailty, and
their health outcomes?
What are the limitations and
gaps in the literature?
1
2
3
6
8. Flowchart of Scoping Review
MEDLINE 785
EMBASE1136
CINAHL 567
Web of Science 547
Scopus 674
PsycInfo 292
Assessed for eligibility:
57
33 articles excluded
Reasons:
N=23 (no frailty measures or
results)
N=8 (no social isolation
measures or results)
N= 2 ( review articles)
Studies meeting the
inclusion criteria:
25
Electronic
search: 4001
studies
Duplicates: 2113
Screened &
excluded: 1888
Inclusion criteria:
1. Community-dwelling older
adults aged 60 years +
2. Measuring social isolation
3. Measuring physical frailty
4. Articles in English and French1 2
3 4 5
From 2001 to June 2018
additional
Articles:3 7
10. 4 5
3
5
5
4
1
4
0
2
4
6
8
10
12
14
16
18
Social Networks Social Support Social Participation Social Isolation Loneliness
Social isolation associated with frailty status
No evidence of association Significant association
1- Results: Social isolation and frailty
9
12. 2- Results: Social Isolation, Frailty and Health Outcomes
3 4
10
9
4
0
2
4
6
8
10
12
Frailty & health Social isolation & health Social isolation & frailty
The association between social isolation, frailty and health
No evidence of association Significant association
Health outcomes:
- Falls
- Disability
- Mortality
- Cognitive decline
- Discharge to the
higher level of care
11
13. 2- Results: Social Isolation, Frailty and Health Outcomes
Social
support
Discharge to
a higher
level of care
Frailty
Functional
decline &
mortality
Social
participation
Frailty
No evidence of interaction effect Evidence of interaction effect
12
14. 3- Gaps: Moderation, Mediation or Interaction Effect
Social isolation Frailty
Moderation effect No study identified No study identified
Mediation effect No study identified No study identified
Interaction effect 2 studies:
Social support & frailty
social participation & frailty
No study identified
Social
Isolation
Health
Outcomes
Frailty
Social
Isolation
Health
OutcomesFrailty
13
?
?
? ?
?
?
15. 3-Limitations and Gaps in included studies
§ Presence of gender inequality ( in 2 Taiwanese studies)
§ Subjective aspect of social isolation or loneliness
o (Social Isolation & Frailty: 4 out of 18)
o(Social Isolation & Frailty & Health: 1 out of 8)
§ Absence of health outcomes: life satisfaction, quality of life,
depression, dementia
Cross-sectional Longitudinalvs
14
16. Social Networks Social Participation Social Support Loneliness
Discussion and conclusion
15
Objective Subjective
Comprising both objective and
subjective aspects of social
isolation
17. Discussion and conclusion
üPossible role of frailty as a moderator and mediator on the relationship between social isolation
and health
üPossible role of social isolation as a moderator and mediator on the relationship between frailty
and health
16
Social
Isolation
Health
Outcomes
Frailty
Social
Isolation
Health
OutcomesFrailty
18. Thank you
17
Direction des affaires internationales
fereshteh.mehrabi@umontreal.ca
@FereshteMehrabi
The comic of my research which is available in my twitter and FAÉCUM’s
Facebook:
19. Selected References
• Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop
WJ, Burke G: Frailty in older adults: evidence for a phenotype. The Journals of Gerontology
Series A: Biological Sciences and Medical Sciences 2001, 56(3):M146-M157
• Berkman LF, Krishna A: Social Network Epidemiology. In: Social Epidemiology. Edited by
Berkman LF, Kawachi I, Glymour MM, 2 edn: Oxford University Press; 2014: 234-289
• Images:
• https://theinnovativeeducator.blogspot.com/2010/04/death-of-freemiums-at-ning-could-mean.html
• https://www.vectorstock.com/royalty-free-vectors/sad-depressed-broken-lonely-vectors
• https://clipground.com/image-post/28338-collaboration-clipart-
14.jpg.html#overlayGallery_post_28338_collaboration-clipart-14.jpg
• https://dumielauxepices.net/sites/default/files/drawn-broken-heart-lonely-516739-6369655.jpg
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