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Frailty Plus Loneliness, Social Isolation Elevates Risk of Death

July 27, 2020

Older adults with frailty are at increased risk of mortality, but the risk is even higher when frailty is combined with loneliness or social isolation. Researchers published their findings online in the Journal of the American Geriatrics Society. 

“Loneliness refers to subjectively perceived deficits in social support or social connections, whereas social isolation is a more objective measure of the lack of social contact,” researchers explained. “This important distinction means that loneliness and social isolation should be considered separately because they cover different aspects of social relationships. For example, not all socially isolated people experience the feeling of loneliness.” 

The study analyzed data gathered over a period of 22 years (1995-2017) for 1427 community-dwelling adults age 65 and older in the Netherlands. Researchers used the frailty phenotype (Fried criteria) to measure frailty, the De Jong Gierveld Loneliness Scale to assess loneliness, and information on partner status, social support, and network size to gauge social isolation. 

Frailty affected 13% of participants, according to the study. In addition to frailty, 5.9% of participants experienced loneliness and 6.2% experienced social isolation.  

While the study identified a hazard ratio for mortality ranging from 1.40 to 1.48 for older adults with frailty compared to older adults without frailty, the highest risk of mortality in the sample was observed in older adults with combined frailty and loneliness or frailty and social isolation. Researchers reported hazard ratios of 1.83 for mortality for older adults with frailty and loneliness and 1.77 for mortality for older adults with frailty and social isolation. 

“In conclusion, this study showed that older adults with frailty who are also lonely or socially isolated constitute a high‐risk group for mortality. This is important information for researchers and clinicians,” researchers wrote. “To optimize well‐being and health outcomes in physically frail older adults, targeted interventions focusing on both subjective and objective social vulnerability are needed.” 

Jolynn Tumolo 


Hoogendijk EO, Smit AP, van Dam C, et al. Frailty Combined with Loneliness or Social Isolation: An Elevated Risk for Mortality in Later Life [published online ahead of print, 2020 Jul 23]. J Am Geriatr Soc. 2020;10.1111/jgs.16716. doi:10.1111/jgs.16716

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