Skip to main content
Download PDF

Physical frailty predicts the development of social frailty: a prospective cohort study

BMC Geriatrics volume 20, Article number: 403 (2020) Cite this article

Abstract

Background

It has not been clarified whether physical frailty symptoms predict social.

frailty. The purpose of this study was to elucidate the effect of physical frailty on social frailty, and to determine which domains of physical frailty predict the development of social frailty.

Methods

We employed a two-year prospective cohort study. A total of 342 socially robust community-dwelling older adults were recruited. We used a modified social frailty screening index consisting of four social domains including financial difficulties, living alone, social activity, and contact with neighbors. Physical frailty status was also assessed at baseline. At the two-year follow-up, we assessed the development of social frailty. Social status was assessed using four social subdomains for the primary analysis. Social status was assessed using the two social subdomains of social activity and contact with neighbors, which would be affected by the physical frailty component, for the secondary analysis. The risk ratios (RR) of physical frailty for the development of social frailty were estimated.

Results

Although physical frailty symptoms were not a significant risk factor for future development of social frailty as assessed by four social subdomains (adjusted RR 1.39, 95% CI 0.95–2.15), it became significant when development of social frailty was assessed by the two social subdomains (adjusted RR 1.78, 95% CI 1.10–2.88). An analysis using the physical frailty subdomain showed that slow gait speed (adjusted RR 3.41, 95% CI 1.10–10.53) and weakness (adjusted RR 1.06, 95% CI 1.01–1.12) were independent risk factors for development of social frailty as assessed by two social subdomains.

Conclusions

Physical frailty symptoms predict the development of social frailty. Among physical frailty subdomains, gait speed and muscle strength are critical independent risk factors for future decline in the social aspect. The prevention of physical frailty, especially by maintaining gait ability and muscle strength, may be effective for avoiding social frailty.

Peer Review reports

Background

Frailty is a state of vulnerability that results in an increased risk of adverse health outcomes related to aging [1]. The concept of frailty includes physical, psychological, and social components [2]. Among them, physical frailty is the most commonly investigated component and has been shown in many studies to predict disability, hospitalization, and mortality [1, 3, 4].

Recently, social frailty has also attracted attention. Social frailty in aging populations is of grave concern because of social issues faced by the elderly such as those related to income, family dynamics, and social inclusion [5]. Although a gold standard assessment for social frailty has not been established yet, several studies have demonstrated the adverse health outcomes attributable to social frailty, such as disability and mortality [5,6,7]. Thus, the prevention of social frailty constitutes an important issue in an ageing society.

Social frailty is one of the risk factors for physical frailty [8], indicating that there is a link between social and physical frailty. Although the basis for the causal relationship between the social frailty component and physical frailty has not necessarily been clarified well, some researchers ascertained that limited social activity or connection, which is a components of social frailty, led to the decline of physical activity (PA) and functioning [9,10,11,12].

Meanwhile, this temporal relationship, namely that social frailty leads to physical frailty, may be a reciprocal rather than a one-way relationship. An earlier study reported that physical functional decline caused limited life-space mobility [13], which would restrict outdoor social activity. However, it has not been clarified whether physical frailty symptoms induce social frailty. We here hypothesize that physical frailty symptoms are a risk factor for social frailty. Further, it is unclear which subdomains of physical frailty closely predict the decline of the social aspect. This knowledge would aid the development of an intervention strategy to prevent a downward spiral of frailty. The purpose of this study was to elucidate the effect of physical frailty on the social frailty aspect, and to determine which domains of physical frailty strongly predict the decline of the social aspect.

Methods

Study design and participants

This study uses a prospective cohort analysis design. Baseline information was gathered in the period September 2015 to December 2017 from the study on Frail Elderly in the Sasayama-Tamba Area (FESTA). Tamba-Sasayama City, with a population of 41,490 as of 2015, is situated in the suburban area of the Hyogo prefecture. The average age of the city’s population is higher than the Japanese average (31.4% aged 65 or above). We recruited community-dwelling older adults to participate by using an community advertisement, placing posters at Sasayama Medical Center, and oral announcements by medical staff in the city. The two-year follow-up assessment was conducted between September 2017 and December 2019 to assess the incidence of the decline of the social frailty component.

The present study targeted participants who at least engaged in social activity or had contact with neighbors, which are potentially related to physical frailty, among subdomains of social frailty. The inclusion criteria were: (1) aged 65 years or older, (2) able to walk independently with/without a cane, and (3) not socially frail/pre-frail at baseline. The exclusion criteria were: (1) cognitive impairment, which was determined by a Mini-Mental State Examination (MMSE) score less than 21 [14], and (2) participants containing missing data.

During the initial phase, 625 older adults participated in the baseline assessment. Among them, 376 met the inclusion criteria (out of 625, 201 were pre-socially frail, and 48 were socially frail). One person was excluded due to cognitive impairment. Out of 375 people, 352 participated in the secondary assessment (23 dropped out), and 10 people had missing data. Accordingly, the study comprised the remaining 342 participants.

Social frailty

We used a modified social frailty index [5] founded on Bunt’s social frailty concept, which measures general and social resources, social behaviors, and the satisfaction of basic social requirements [15]. The screening index was developed to briefly assess social frailty status, which can predict future incidents of activity limitation and mortality in community-dwelling older adults [5]. The question regarding general resources (financial difficulties) is: “Do you have a financial problem in your daily life?” Financial difficulty was defined as a “yes” answer. The question regarding social resources (living alone) is: “How many people do you live with?” Inadequate social resources were reflected in the answer “alone.” The question pertaining to social behavior (lack of social activity) is: “Do you participate in any community activities or volunteer activities?” Poor social behavior was defined as an answer “none.” The question assessing the satisfaction of basic social requirements (lack of contact with neighbors) is: “Do you sometimes visit your friends?” Deficiency in basic social needs was identified as a “no” answer. A score of 2 or more was defined as social frailty, 1 as pre-social frailty, and 0 as social robustness.

Physical frailty

We assessed physical frailty status according to the Fried phenotype [1, 16]: (1) slow gait speed, (2) weakness, (3) exhaustion, (4) low activity, and (5) weight loss. Participants who did not show any of these five symptoms were considered non-frail, while those with one or two symptoms were defined as pre-frail. For the assessment of gait speed, we asked participants to cover a 12 m walkway at their usual speed. Then, the time for 10 m in the way was assessed [17]. Slowness was determined by a cut-off point less than 1.0 m/s [1]. We measured maximum grip strength by using a grip strength tester (GRIP-A; Takei Ltd., Niigata, Japan). Strength weakness was identified according to established cut-off (< 26 kg for men, < 18 kg for women) [18]. We assessed exhaustion with the following question from the Kihon Check List [19]: “In the last two weeks, have you felt tired without a reason?” Weight loss was assessed with the following question: “Have you lost 2 kg or more in the past six months?” [19]. PA was assessed with a wrist wearable accelerometer (Actiband, TDK Co., Tokyo, Japan) for 14 days. The epoch duration for recording PA was 5 min. The reliability and validity of this accelerometer have been confirmed previously [20]. Data from participants with complete measurements recorded for at least 3 days were included in the analysis. Participants who did not record at least 600 min of PA were excluded [21]. We defined lower than 1 standard deviation away from mean of moderate to vigorous PA (MVPA, ≥3 METs) [22] in the participants as low PA.

Other variables

Each subject’s age, sex, comorbidity, and education were self-reported. We used the Geriatric Depression Scale (GDS) [23] to assess depressive symptoms. We also assessed the Instrumental Activity of Daily Living (IADL) using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) [24] and participants’ history of falls in the previous year.

Outcome measure

The social frailty score (four domains) was used as the primary outcome. We re-assessed it during the two-year follow-up, and categorized participants into a socially maintained or socially declined group according to their change in social score (four domains) to clarify the temporal relationship between physical frailty and social frailty. As the secondary analysis, we focused on social behavior (social activity) and fulfillment of basic social needs (contact with neighbors) in the social frailty index, which would be affected by the physical components because the two activities require physical movement. We accordingly excluded the remaining two social variables in the secondary analysis, general resources (economic hardship), and social resources (living alone), because they may be difficult to control using the physical aspect in older adults.

Statistical analysis

The participant’s characteristics assigned to the physically robust and pre-frailty or frailty (with any frailty subdomain) groups at the baseline were compared by using a Student’s t-test, Mann–Whitney U, or chi-square tests according to the type of variables. We also assessed the baseline differences between the socially maintained and socially declined groups (four domains) during the two-year follow-up. A modified Poisson regression model [25] was used to estimate the risk ratio (RR) and 95% confidence intervals (CIs) of physical frailty for the development of social frailty (four domains) in the crude and adjusted model as a primary analysis. First, the physical frailty condition (robust or any-frailty) was included as an independent variable. Second, five subdomains of physical frailty were entered using the forced entry method. Of those, we added walking speed, handgrip strength, and PA as continuous variables. The adjusted model added age, sex, MMSE, GDS, multimorbidity (two or more chronic illnesses), IADL score, and fall experience as covariates. As a secondary analysis, we assessed the incidence risk of development of social frailty focusing on social activity and contact with neighbors in the social frailty index, domains which possibly have a direct relationship with physical components. Data were analyzed using IBM SPSS ver. 24 (IBM Japan Ltd., Tokyo, Japan). Statistical significance was set at p < 0.05.

Results

Table 1 presents the participants’ characteristics according to their physical frailty condition at baseline. Of the 342 participants, 232 (68%) were classified as physically robust and 110 (32%) showed one or more physical frailty symptoms. Participants classified as physically any level of frailty showed a higher GDS score, higher prevalence of history of falls, lower gait speed, lower strength, and lower MVPA.

Table 1 Baseline characteristics in participants
Full size table

At the two-year follow-up, 12 (4%) of 342 participants were categorized as socially frail, and 53 (15%) were socially pre-frail (Table 2); overall, 65 participants showed some development of social frailty. The social changes in each subdomain are shown in Table 2. Eleven people (3%) began to feel financial difficulty, and eleven people (3%) changed to living alone. Regarding lack of social activity, 50 participants (15%) lost their activity. Six people (2%) lost their ability to have contact with neighbors. By comparing baseline characteristics between the socially maintained and socially declined groups (by four domains) during the two-year follow-up, there were significant differences in age, sex, height, GDS, history of falls, gait speed, handgrip strength, and MVPA.

Table 2 Baseline differences between the socially robust and socially declined groups during the two-year follow-up
Full size table

According to the modified Poisson regression, the presence of physical frailty symptoms was not a significant risk factor for development of social frailty by four domains (crude RR 1.50, 95% CI 0.97–2.32, adjusted RR 1.39, 95% CI 0.90–2.15) (Table 3). An analysis using the physical frailty subdomain showed that weakness was an independent risk factor for development of social frailty by four subdomains (adjusted RR 1.05, 95% CI 1.00–1.11). Meanwhile, focusing on development of social frailty by two domains (social activity and contact with neighbors), physical frailty symptoms were significantly related to development of social frailty. Subdomain analysis showed that slow gait speed and muscle weakness were significant risk factors for development of social frailty by two domains.

Table 3 Risk ratios for the development of social frailty after two years according to physical frailty subdomains
Full size table

Discussion

The current prospective cohort study investigated the effect of physical frailty on the social frailty, and assessed the effect of each subdomain of physical frailty on the future decline of the social aspect. Physical frailty symptoms were not necessarily related to the development of social aspects assessed by all subdomains. Only muscle weakness was associated with development of social frailty. Meanwhile, when focusing on social aspects assessed by the two subdomains of social activity and contact with neighbors, physical frailty symptoms were a risk factor predictive of development of social frailty. Among the subdomains of physical frailty, slow gait speed and muscle weakness were the critical domains that related to changes in them.

The effects of the social aspect on physical condition have been reported in several studies. Earlier studies have uncovered that the decline of social aspects in older people, including social relations, social engagement, and social connection, was related to physical functioning decline [10, 26, 27]. In recent studies, social frailty emerged as a risk factor for the incidence of physical frailty, disability and mortality [5,6,7,8]. Poor social connectedness contributes to low PA [10], which likely induces a decline of physical functioning [12]. On the contrary, the present study demonstrated a reverse relationship in that physical frailty leads to social aspect declines assessed by social activity and contact with neighbors. Older adults with physical limitations are likely to be physically inactive [11], and low physical functioning restricts life-space mobility [13], which likely restricts outdoor social activity. Considering the relationship between physical and social factors reported previously, the results of the present study seem to be reasonable.

The significant relationship between physical and social frailty was underlined when focusing on the two social domains of social activity and contact with neighbors, rather than on the four social domains that include living alone and financial difficulty. A change to living alone seems to be an environmental factor, which is difficult to control through personal physical function because it includes death in the family. Regarding financial difficulty, recruited participants were aged 65 or older in this study; thus, it is considered that many people are already retired and living on pension in Japan. Financial conditions in those people may not be affected by physical aspects. Based on these ideas, we presumed that the relationship between physical frailty and social frailty would become obvious in the secondary analysis. Out of the four domains, the development of lack of social activity was the most prevalent (15%). We assume that outdoor social activity requires higher physical function than contact with neighbors, which can be achieved in the limited area around their house. Assessing lack of social activity may thus lead to better sensitivity for assessing the development of social frailty.

Among the physical frailty subdomains, lower gait speed and muscle strength were independently predictive of development of social frailty. An earlier study reported that low physical functioning was a risk factor for limited life-space mobility [13]. The ability to walk safely is a prerequisite to going outdoors independently [28]. We therefore consider the present result of slow gait speed as a relevant risk factor. Regarding the relationship between the social aspect and muscle weakness, Haraldstad et al. conducted the intervention with strength training and reported that increase of strength was related to improvement in social function [29]. The other study mentioned a negative association with social function (including social contact with friends and neighbors) and fear of falling in the elderly [30]. The fear of falling is a known risk factor for avoidance of going outside [31], and this fear has been reported to be related to muscle weakness [32]. Accordingly, muscle weakness may be a predictor of future social frailty via fear of falling. The results of this study suggest the possibility that intervention that targets gait speed and muscle strength is effective in avoiding future social frailty among older adults.

Our results coupled with the reported result that social frailty predicts physical frailty [8], implicate a hypothetical model wherein social frailty and physical frailty are interinfluenced. The model could provide a new intervention concept that will help prevent the negative loop of social/physical frailty. However, the present study was an observational study, which potentially include bias and unknown confounders; thus, causal associations between physical and social aspects should be carefully interpreted. Additionally, the relationship between social and physical aspects are not necessarily simple. Ma et al. demonstrated that social frailty was associated with not only physical functioning, but also cognitive function and depression [7]. Clinicians may need to consider the interactions of psychological and physical functioning in order to prevent social frailty in the elderly. Leastwise, present results suggest the necessity of supposing reciprocal effects between physical and social factors, as well as the importance of assessing both factors to understand the future risk of adverse health outcomes.

The present study had some limitations. First, participants were recruited via an advertisement in a community newspaper or oral announcements, depending on their motivation to participate. This may have involved a bias in that the recruited participants tended to have lower development of social frailty. Second, we did not include participants with cognitive decline to prioritize the reliability of assessments. Cognitive impairment would influence social aspects [7]. This study could not make reference to the effect of cognitive impairment on the relationship between physical and social frailty. Third, we could not consider the effect of geographical information and trauma on the development of social frailty.

Conclusions

Our study underscores the fact that symptoms of physical frailty often predict the development of social frailty. Additionally, among the subdomains of physical frailty, lower gait speed and muscle strength are critical independent risk factors for future decline of social aspects. The prevention of physical frailty, especially by maintaining gait ability and muscle strength, may be an effective solution for avoiding social frailty.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

RR:

Risk Ratio

PA:

Physical Activity

MMSE:

Mini-Mental State Examination

MVPA:

Moderate to Vigorous Physical Activity

IADL:

Instrumental Activity of Daily Living

TMIG-IC:

Tokyo Metropolitan Institute of Gerontology Index of Competence

GDS:

Geriatric Depression Scale

CI:

Confidence Interval

References

  1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.

    CAS  Article  Google Scholar 

  2. Rockwood K. What would make a definition of frailty successful? Age Ageing. 2005;34(5):432–4.

    Article  Google Scholar 

  3. Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, Hillier TA, Cauley JA, Hochberg MC, Rodondi N, et al. Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch Intern Med. 2008;168(4):382–9.

    Article  Google Scholar 

  4. Yamada M, Arai H. Predictive value of frailty scores for healthy life expectancy in community-dwelling older Japanese adults. J Am Med Dir Assoc. 2015;16(11):1002.e7–11.

  5. Yamada M, Arai H. Social frailty predicts incident disability and mortality among community-dwelling Japanese older adults. J Am Med Dir Assoc. 2018;19(12):1099–103.

    Article  Google Scholar 

  6. Makizako H, Shimada H, Tsutsumimoto K, Lee S, Doi T, Nakakubo S, Hotta R, Suzuki T. Social Frailty in Community-Dwelling Older Adults as a Risk Factor for Disability. J Am Med Dir Assoc. 2015;16(11):1003 e1007–11.

    Article  Google Scholar 

  7. Ma L, Sun F, Tang Z. Social frailty is associated with physical functioning, cognition, and depression, and predicts mortality. J Nutr Health Aging. 2018;22(8):989–95.

    CAS  Article  Google Scholar 

  8. Makizako H, Shimada H, Doi T, Tsutsumimoto K, Hotta R, Nakakubo S, Makino K, Lee S. Social Frailty Leads to the Development of Physical Frailty among Physically Non-Frail Adults: A Four-Year Follow-Up Longitudinal Cohort Study. Int J Environ Res Public Health. 2018;15(3):490.

  9. Buchman AS, Boyle PA, Wilson RS, Fleischman DA, Leurgans S, Bennett DA. Association between late-life social activity and motor decline in older adults. Arch Intern Med. 2009;169(12):1139–46.

    Article  Google Scholar 

  10. Clarke CL, Sniehotta FF, Vadiveloo T, Argo IS, Donnan PT, McMurdo MET, Witham MD. Factors associated with change in objectively measured physical activity in older people - data from the physical activity cohort Scotland study. BMC Geriatr. 2017;17(1):180.

    Article  Google Scholar 

  11. Yi X, Pope Z, Gao Z, Wang S, Pan F, Yan J, Liu M, Wu P, Xu J, Wang R. Associations between individual and environmental factors and habitual physical activity among older Chinese adults: a social-ecological perspective. J Sport Health Sci. 2016;5(3):315–21.

    Article  Google Scholar 

  12. Mendes de Leon CF, Glass TA, Berkman LF. Social engagement and disability in a community population of older adults: the New Haven EPESE. Am J Epidemiol. 2003;157(7):633–42.

    Article  Google Scholar 

  13. Portegijs E, Rantakokko M, Mikkola TM, Viljanen A, Rantanen T. Association between physical performance and sense of autonomy in outdoor activities and life-space mobility in community-dwelling older people. J Am Geriatr Soc. 2014;62(4):615–21.

    Article  Google Scholar 

  14. Perneczky R, Wagenpfeil S, Komossa K, Grimmer T, Diehl J, Kurz A. Mapping scores onto stages: mini-mental state examination and clinical dementia rating. Am J Geriatr Psychiatry. 2006;14(2):139–44.

    Article  Google Scholar 

  15. Bunt S, Steverink N, Olthof J, van der Schans CP, Hobbelen JSM. Social frailty in older adults: a scoping review. Eur J Ageing. 2017;14(3):323–34.

    CAS  Article  Google Scholar 

  16. Shimada H, Makizako H, Doi T, Yoshida D, Tsutsumimoto K, Anan Y, Uemura K, Ito T, Lee S, Park H, et al. Combined prevalence of frailty and mild cognitive impairment in a population of elderly Japanese people. J Am Med Dir Assoc. 2013;14(7):518–24.

    Article  Google Scholar 

  17. Lopopolo RB, Greco M, Sullivan D, Craik RL, Mangione KK. Effect of therapeutic exercise on gait speed in community-dwelling elderly people: a meta-analysis. Phys Ther. 2006;86(4):520–40.

    Article  Google Scholar 

  18. Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, Chou MY, Chen LY, Hsu PS, Krairit O, et al. Sarcopenia in Asia: consensus report of the Asian working Group for Sarcopenia. J Am Med Dir Assoc. 2014;15(2):95–101.

    Article  Google Scholar 

  19. Fukutomi E, Okumiya K, Wada T, Sakamoto R, Ishimoto Y, Kimura Y, Chen WL, Imai H, Kasahara Y, Fujisawa M, et al. Relationships between each category of 25-item frailty risk assessment (Kihon checklist) and newly certified older adults under long-term care insurance: a 24-month follow-up study in a rural community in Japan. Geriatr Gerontol Int. 2015;15(7):864–71.

    Article  Google Scholar 

  20. Nagai K, Miyamato T, Okamae A, Tamaki A, Fujioka H, Wada Y, Uchiyama Y, Shinmura K, Domen K. Physical activity combined with resistance training reduces symptoms of frailty in older adults: a randomized controlled trial. Arch Gerontol Geriatr. 2018;76:41–7.

    Article  Google Scholar 

  21. Trost SG, Pate RR, Freedson PS, Sallis JF, Taylor WC. Using objective physical activity measures with youth: how many days of monitoring are needed? Med Sci Sports Exerc. 2000;32(2):426–31.

    CAS  Article  Google Scholar 

  22. Norton K, Norton L, Sadgrove D. Position statement on physical activity and exercise intensity terminology. J Sci Med Sport. 2010;13(5):496–502.

    Article  Google Scholar 

  23. Sugishita K, Sugishita M, Hemmi I, Asada T, Tanigawa T. A validity and reliability study of the Japanese version of the geriatric depression scale 15 (GDS-15-J). Clin Gerontol. 2017;40(4):233–40.

    Article  Google Scholar 

  24. Koyano W, Shibata H, Nakazato K, Haga H, Suyama Y. Measurement of competence: reliability and validity of the TMIG index of competence. Arch Gerontol Geriatr. 1991;13(2):103–16.

    CAS  Article  Google Scholar 

  25. Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–6.

    Article  Google Scholar 

  26. McAuley E, Blissmer B, Marquez DX, Jerome GJ, Kramer AF, Katula J. Social relations, physical activity, and well-being in older adults. Prev Med. 2000;31(5):608–17.

    CAS  Article  Google Scholar 

  27. Jang Y, Park NS, Dominguez DD, Molinari V. Social engagement in older residents of assisted living facilities. Aging Ment Health. 2014;18(5):642–7.

    Article  Google Scholar 

  28. Manini TM. Mobility decline in old age: a time to intervene. Exerc Sport Sci Rev. 2013;41(1):2.

    Article  Google Scholar 

  29. Haraldstad K, Rohde G, Stea TH, Lohne-Seiler H, Hetlelid K, Paulsen G, Berntsen S. Changes in health-related quality of life in elderly men after 12 weeks of strength training. Eur Rev Aging Phys Act. 2017;14:8.

    Article  Google Scholar 

  30. Lachman ME, Howland J, Tennstedt S, Jette A, Assmann S, Peterson EW. Fear of falling and activity restriction: the survey of activities and fear of falling in the elderly (SAFE). J Gerontol B Psychol Sci Soc Sci. 1998;53(1):43–50.

    Article  Google Scholar 

  31. Bertera EM, Bertera RL. Fear of falling and activity avoidance in a national sample of older adults in the United States. Health Soc Work. 2008;33(1):54–62.

    Article  Google Scholar 

  32. Sadowska D, Osinski W, Gumny M. Muscle strength of lower limbs as a predictor of postural stability and fear of falling in physically active and inactive older men and women. Topic Geriat Rehab. 2018;34(2):124–30.

    Article  Google Scholar 

Download references

Acknowledgements

The authors acknowledge Ryo Kitano, Saya Tanaka, and Rina Furukawa for their contribution to data collection.

Funding

This work was supported by JSPS KAKENHI [Grant number: JP16KT0012 and JP19K19723] and the Mitsui Sumitomo Insurance Welfare Award, a grant in the field of Senior Citizen Welfare (2020) (Dr. Shinmura). The funding sources had no role in the design of the study, collection, analysis, interpretation of data, nor in writing the manuscript.

Author information

Affiliations

  1. Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, 1-3-6 Minatojima, Chuo-ku, Kobe, Hyogo, 650-8530, Japan

    Koutatsu Nagai, Seiya Hayashitani, Ryota Yokoyama & Ryo Yonezawa

  2. Department of General Medicine, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan

    Kayoko Tamaki, Hiroshi Kusunoki & Ken Shinmura

  3. Department of Rehabilitation, Hyogo College of Medicine Sasayama Medical Center, 5 Kurooka, Sasayama, Hyogo, 669-2321, Japan

    Yosuke Wada

  4. Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo, 663-8501, Japan

    Shotaro Tsuji

  5. Department of Occupational Therapy, School of Rehabilitation, Hyogo University of Health Sciences, 1-3-6 Minatojima, Chuo-ku, Kobe, Hyogo, 650-8530, Japan

    Masako Itoh & Kyoko Sano

  6. School of Pharmacy, Hyogo University of Health Sciences, 1-3-6 Minatojima, Chuo-ku, Kobe, Hyogo, 650-8530, Japan

    Manabu Amano

  7. Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshidakonoe-cho, Sakyo-ku, Kyoto, Kyoto, 606-8501, Japan

    Tsukasa Kamitani

Authors
  1. Koutatsu Nagai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kayoko Tamaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroshi Kusunoki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yosuke Wada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shotaro Tsuji
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masako Itoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kyoko Sano
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Manabu Amano
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Seiya Hayashitani
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ryota Yokoyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ryo Yonezawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Tsukasa Kamitani
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Ken Shinmura
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KN and KS2 were involved in the original conception and design of the study. Data acquisition was conducted by KN, KT, HK, YW, ST, MI, KS1, MA, SH, RY1, RY2. TK and KS2 conducted statistical analysis and interpretation of data. KN, TK and KS2 drafted the manuscript. KT, HK, YW, ST, MI, KS1, MA, SH, RY1 and RY2 conducted critical revision of the manuscript for important intellectual content. All Authors read and approved the final manuscript.

Corresponding author

Correspondence to Koutatsu Nagai.

Ethics declarations

Ethics approval and consent to participate

This study was approved by the ethics review board of Hyogo College of Medicine (No Rinhi 0342) and was conducted in accordance with the Declaration of Helsinki. Participants received oral and written explanations concerning the study and provided their written consent prior to the commencement of the study.

Consent for publication

Not applicable.

Competing interests

The authors have no conflict of interest directly relevant to the content of this article.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Nagai, K., Tamaki, K., Kusunoki, H. et al. Physical frailty predicts the development of social frailty: a prospective cohort study. BMC Geriatr 20, 403 (2020). https://doi.org/10.1186/s12877-020-01814-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12877-020-01814-2

Keywords

  • Social frailty
  • Physical frailty
  • Older adults