Socialising could reverse frailty in older people

An estimated 10 per cent of people over the age of 65 are living with frailty, which can entail being more tired, slower or less strong, and can increase the risk of having a fall or being hospitalised. But the new study, led by Newcastle University, suggests that engaging in social activities could help people reverse physical frailty, or come back from the brink of frailty. 

Voluntary work 

These activities include:

Spending time with friends and family 

Playing bingo or card games like bridge  

Going on holiday 

Going out for meals  

Writing letters 

Voluntary work 

This is based on almost 2,000 people asked about engaging in social activities including the list above and revisited up to eight years later. Those who became more socially active over the years were up to 79 per cent more likely to reverse their frailty, or any early signs of frailty, and become more physically robust, according to the study.  

The research included 715 men from the four-decade British Regional Heart Study, supported by the British Heart Foundation, and 1,256 men and women from a similar study in the US. 

"Frailty is not inevitable"

Sheena Ramsay, Professor of Public Health & Epidemiology at Newcastle University, and Director of Fuse, the Centre for Translational Research in Public Health, who is senior author of the research, said: “Our study shows that frailty is not inevitable. Some people recover from early stages of frailty – becoming more socially active could be one of the factors that can make this happen.” 

Dr Ziyi Cai, first author of the study from Newcastle University, said: “People who are socially connected may have friends and loved ones supporting them to have healthier lives and access to healthcare, which could ward off frailty. 

“On the other hand, people who are more isolated, and feel lonely, may be less active, less likely to get the care they need for their health, and sleep and eat less well – all of which can increase their risk of living with frailty. 

“Age-friendly communities and networks that foster supportive social ties and activities could contribute to reducing the burden of frailty.” 

The groups of older people in the UK and US studies were asked how much they engaged in 10 social activities during a typical week. These included spending time with family, friends and neighbours, playing cards, games or bingo, going on holidays or overnight trips, reading books or newspapers, using the internet or writing letters, and attending courses or public meetings. 

The 10 social activities also included a category for eating out in a restaurant or visiting the cinema, a museum or sports event, with a separate category for taking part in social clubs or religious activities like church groups, and two categories for whether people did paid work or voluntary work.  

If participants did a social activity at least once in a typical week, they were given a score of one for that activity, while those that did not scored zero. This added up to a possible score of 10 for the full list of 10 activities. Researchers were able to look at people who were closely matched for factors like their age, sex, health problems, and whether they were living with obesity. 

The results reveal that for two closely matched British men, if one had a score one point higher than the other for social activities, they would be 31 per cent less likely to end up living with frailty. Among the people in the US study, a person with a score one-point higher for social activities would be 44 per cent less likely to live with frailty. 

71 per cent more likely to reverse

Even someone who was not very sociable, if they increased their social activities over time, could improve their physical health, the results suggest. For the British men studied, those who started off with frailty or ‘pre-frailty’ were 71 per cent more likely to reverse this if they increased their social activities over the eight-year period studied. For the US group, those who increased their social activities over a four-year study period were 79 per cent more likely to reverse frailty and pre-frailty and become more physically robust. 

Only a quarter of people over the age of 85 are classed as people living with frailty. In the study, frailty was measured based on how slowly people walked and stood up from a chair, if they had a poor grip which indicated weakness, if they had a low amount of physical activity, and if they displayed exhaustion or unintentional weight loss. 

If none of these five issues were identified, it meant someone was judged to be physically robust. People living with pre-frailty had one or two of these issues, and people living with frailty had three or more. 

Loneliness was also linked to frailty in the US study, with people who were lonelier being 42 per cent more likely to end up living with frailty. If people became lonelier over the eight years of the British study, they were 50 per cent more likely to develop frailty, although this link with loneliness over time was not seen in the US group. 

Evolutionarily programmed

The British men were asked how often they felt they lacked companionship, felt isolated, not in tune with people around them or left out, while the US group were asked simply how often they felt lonely. Experts suspect, because we needed other people to protect us from danger in our hunter-gatherer past, that people who feel lonely and unsupported are evolutionarily programmed to be more vigilant for potential threats to their safety and wellbeing, causing a constant level of stress which is damaging to health. 

Loneliness can affect people who are very sociable, and seem to have lots of friends, but who do not feel they have people they can rely on. The study was funded by the Vivensa Foundation. The British Regional Heart Study is funded with major grants from the British Heart Foundation, Medical Research Council, the  Vivensa Foundation and the National Institute for Health & Care Research. 

"Isolation can be detrimental"

Sonya Babu-Narayan, Clinical Director at the British Heart Foundation and consultant cardiologist, said: “This study adds to a growing body of evidence that social activities are good for our health, while loneliness and isolation can be detrimental. Exercise, such as resistance or strength training and maintaining good nutrition, are major factors which can reduce frailty. 

“There is a growing focus in the NHS on ‘social prescribing’, which helps people embrace doing new things in their local area. Trying new group activities like volunteering, for those who can, may help to keep living well for longer.”

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