CNN
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Suppose there are three women in their mid-70s. All of them have similar illnesses such as diabetes, arthritis, and high blood pressure, and all live alone in the same financial situation.
Green spends most of her time at home, sometimes going for a week without seeing anyone. However, she is in frequent phone contact with her friends and relatives, and she also takes virtual classes in a discussion group at a nearby university.
Mr. Smith is also at home, but he hardly speaks to anyone. She has lost contact with her friends, she no longer goes to church and spends most of her time watching TV.
Ms. Johnson has a wide range of friendships and a busy schedule. She takes regular walks with her neighbors, twice a week she volunteers at a local school, goes to church, and stays in close contact with children who don’t live nearby.
Three social situations, three levels of risk when a woman experiences a fall, pneumonia, or serious health deterioration.
Experts say Johnson is the most likely of the women to be taken to a doctor or hospital. Several people may check on Mr. Greene and arrange for assistance until he recovers.
But Smith is unlikely to get much help if her health deteriorates, and she is likely to fare worse than others. She is what some experts call a “social pariah” or “social pariah.”
Social frailty is an inevitable consequence of physical frailty, and a set of vulnerabilities (such as weakness, fatigue, unintentional weight loss, slowness of movement, and reduced physical activity) can lead to falls, disability, hospitalization, and surgery. It has been shown to increase the risk of poor outcomes and nursing home admission. and premature death in the elderly.
Basically, physically frail people have less physiological strength and less biological ability to recover from illness or injury.
Socially vulnerable groups similarly have fewer resources available to them, but for different reasons. This means they do not have close relationships, are unable to rely on others for help, are not actively involved in community groups or religious organizations, or live in socially vulnerable areas. . Feeling unsafe, among other situations. Social vulnerability may also involve feeling out of control over one’s life or feeling disrespected by others.
Many of these factors, along with so-called social determinants of health, such as low socio-economic status, malnutrition, unstable housing, and inaccessible transportation, are associated with poor health outcomes in later life. .
Social frailty posits that each factor contributes to vulnerability in older adults, and that they influence and build on each other.
Dr. Melissa Andrew, a professor of geriatric medicine at Dalhousie University in Halifax, Nova Scotia, who published one of the first social vulnerability indices for older adults, says, “This is more important than any single factor alone. “This will give us a more complete picture of the situation.” In 2008.
This idea about the social lives of older people and how they affect health outcomes is receiving renewed attention from experts in the United States and elsewhere. In February, researchers from Massachusetts General Hospital and the University of California, San Francisco published the 10-item Social Frailty Index in the Proceedings of the National Academy of Sciences.
Using data from 8,250 adults aged 65 and older who participated in the National Health and Retirement Study from 2010 to 2016, the researchers found that this indicator showed that a significant number of older adults died during the study period. They found it useful in predicting increased risk and complemented medical tools. used for this purpose.
“Our goal is to help clinicians identify socially frail older patients and facilitate problem-solving to help them cope with a variety of challenges,” said co-author and researcher at Massachusetts General Hospital. said Dr. Sachin Shah.
“This adds an additional dimension to what clinicians need to know about their patients beyond current screening measures that focus on physical health,” says frailty researcher and Columbia University Mailman School of Public Health. said Dr. Linda Freed, dean of .
Beyond medicine, Fried said the issues raised by this index – older adults’ ability to work, volunteer and interact with others – require society to build solutions. . the safety and accessibility of the areas where they live; Age discrimination and discrimination against the elderly. more.
Meanwhile, a team of Chinese researchers recently published a comprehensive review of social frailty in adults over 60, based on the results of dozens of studies involving approximately 83,900 people in Japan, China, South Korea, and Europe. announced. Researchers determined that 24% of older adults assessed both in hospital and in the community were socially frail. This rate is higher than those considered physically frail (12%) or cognitively frail (9%) in other studies. The most vulnerable people were those over 75 years old.
What are the health care implications? “People who are socially vulnerable will probably need more help at home while recovering from surgery. “We may need them to advocate for us,” says Dr. Kenneth Kovinski, a geriatrician at the University of California, San Francisco, and co-author of a recent paper in the Proceedings of the National Academy of Sciences.
“The Social Frailty Index identifies older adults with special needs and directs them to community resources,” said Jennifer Aylshire, associate professor of gerontology and sociology at the University of Southern California’s Leonard Davis School of Gerontology. I can see that it will help.”
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Elderly people who are socially vulnerable may need additional medical support.
Unlike other physicians, geriatricians regularly screen older adults for additional needs, although they do not use a consistent set of well-vetted measures. “I ask, ‘Who are you most dependent on and how?’ Do they bring you food? Do they drive you somewhere? Why don’t you check in on me? Can you give me your time and attention?”’ said Arthur M. Coppola Family of Supportive Care Medicine at City of Hope Comprehensive Cancer Center in Duarte, California. Chair Dr. William Dale said.
Depending on the patient’s answers, Dale may refer the patient to a social worker or help modify the care plan. But he cautioned that primary care doctors and specialists don’t routinely spend their time doing this.
Oak Street Health, a Chicago-based company with 169 primary care centers for seniors in 21 states and recently acquired by CVS Health, is changing the game with its clinics. , said Dr. Ali Khan, the company’s chief medical officer of value. Care strategies based on.
At least three times a year, medical assistants, social workers, or clinicians ask patients about loneliness and social isolation, transportation barriers, food insecurity, financial strain, housing quality and safety, and access to broadband and public services. Ask about access.
The organization combines these findings with patient-specific medical information in its “Global Risk Assessment,” which categorizes older adults into four tiers from very high risk to very low risk. This informs the patient’s personal health plan, including the types of services provided, frequency of service delivery, and social and medical priorities.
Khan said the central question is “what is the ability of this patient to continue on a path of resilience in the face of a very complex health care system?” And what Oak Street Health can do to strengthen it.
But what is left out of this approach is what matters to older people: whether their relationships with other people are positive or negative. This is not usually measured, but is essential in considering whether their social needs are being met, said George Herbert Mead Distinguished Service Professor of Sociology at the University of Chicago and National Society of Social Sciences. said Linda Waite, director of the Department of Living, Health and Aging. project.
For older adults who want to think about their own social vulnerabilities, consider this five-point index developed by Japanese researchers.
1. Have you gone out less often than last year?
2. Do you sometimes visit friends?
3. Do you feel helpful to your friends and family?
Four. do you live alone?
Five. Do you talk to someone every day?
Let’s think about the answer. If you’re not satisfied with your reactions, it may be time to reevaluate your social situation and make changes.