Social Frailty and Executive Function: Association with Geriatric Syndromes, Life Space and Quality of Life in Healthy Community-Dwelling Older Adults

Abstract

Background: Despite emerging evidence about the association between social frailty and cognitive impairment, little is known about the role of executive function in this interplay, and whether the co-existence of social frailty and cognitive impairment predisposes to adverse health outcomes in healthy community-dwelling older adults. Objectives: We aim to examine independent associations between social frailty with the MMSE and FAB, and to determine if having both social frailty and cognitive impairment is associated with worse health outcomes than either or neither condition. Methods: We studied 229 cognitively intact and functionally independent community-dwelling older adults (mean age= 67.2±7.43). Outcome measures comprise physical activity; physical performance and frailty; geriatric syndromes; life space and quality of life. We compared Chinese Mini Mental State Examination (CMMSE) and Chinese Frontal Assessment Battery (FAB) scores across the socially non-frail, socially pre-frail and socially frail. Participants were further recategorized into three subgroups (neither, either or both) based on presence of social frailty and cognitive impairment. Cognitive impairment was defined as a score below the educational adjusted cut-offs in either CMMSE or FAB. We performed logistic regression adjusted for significant covariates and mood to examine association with outcomes across the three subgroups. Results: Compared with CMMSE, Chinese FAB scores significantly decreased across the social frailty spectrum (p<0.001), suggesting strong association between executive function with social frailty. We derived three subgroups relative to relationship with socially frailty and executive dysfunction: (i) Neither, N=140(61.1%), (ii) Either, N=79(34.5%), and (iii) Both, N=10(4.4%). Compared with neither or either subgroups, having both social frailty and executive dysfunction was associated with anorexia (OR=4.79, 95% CI= 1.04-22.02), near falls and falls (OR= 5.23, 95% CI= 1.10-24.90), lower life-space mobility (odds ratio, OR=9.80, 95% CI=2.07-46.31) and poorer quality of life (OR= 13.2, 95% CI= 2.38-73.4). Conclusion: Our results explicated the association of executive dysfunction with social frailty, and their synergistic relationship independent of mood with geriatric syndromes, decreased life space and poorer quality of life. In light of the current COVID-19 pandemic, the association between social frailty and executive dysfunction merits further study as a possible target for early intervention in relatively healthy older adults.

Cognitive Reserve and Frontotemporal Disorders: Exploring the Relationship Between Education, Physical Activity, and Cognitive Dysfunction in Older Adults

“…Previous studies have shown that this correlation is often high, as individuals with FTD often show signs of general cognitive impairment (Goh et al, 2019;Slachevsky et al, 2004). Furthermore, the impact of cognitive reserve on cognitive function has been highlighted in both individuals at risk for FTD and those without, which adds novelty to our findings (Ong et al, 2021;Coen et al, 2016). Despite limitations, the inclusion of the effect of cognitive reserve in our analysis enriches an understanding of its role in different clinical contexts (Pellas & Damberg, 2024;Woodford & George, 2007).…”

Supplementation with Flaxseed Oil Rich in Alpha-Linolenic Acid Improves Verbal Fluency in Healthy Older Adults

“…The executive function is a higher-level function of the verbal fluency task [ 28 ] and is recognized as one of the key factors associated with the ability to set goals, make plans, modify and adjust while actually performing the actions, and carrying out effective actions in everyday life [ 29 ]. Thus, it is related to the ability of daily living/instrumental activities of daily living (ADL/IADLs) [ 30 , 31 ], social frailty [ 32 ] and importantly, life satisfaction [ 33 ] for older adults. In fact, such a simple verbal fluency task has a rather complex mechanism, as many cognitive functions are interrelated during this task, including semantic memory, dialectical lexical retrieval, information processing speed, inhibition, working memory, shifting performance and cognitive flexibility [ 29 ], and it includes a variety of anatomical sites.…”

Cross-cultural adaptation and psychometric evaluation of the social frailty scale in Iranian older adults

“…Frailty can occur due to adverse health outcomes, including physical conditions (e.g., heart failure), psychological conditions (e.g., cognitive impairment), and social conditions (e.g., isolation) [ 6 ]. The consequences of frailty in older adults include reduced motor function [ 7 ], falls [ 8 ], mental disorders [ 9 ], increased hospitalization rates [ 10 ], and death [ 11 , 12 ]. Frailty is a multidimensional concept that encompasses physical, mental, and social dimensions [ 1 ].…”

“…The SFS-8 assesses social frailty using eight items and three dimensions, including social resources, social activities and financial resources, and fulfillment of social needs [ 22 ]. The SFS-8 has been used in many studies, especially in Asian countries [ 12 , 13 , 24 ].…”