Background It is unclear whether social isolation and loneliness may precede frailty status or whether frailty may precipitate social isolation and loneliness. We investigated the reciprocal and temporal sequence of social isolation, loneliness, and frailty among older adults across 21 years. Methods We used seven waves of the Longitudinal Aging Study Amsterdam from 2302 Dutch older adults (M = 72.6 years, SD = 8.6, 52.1% female) ages 55 or older. Using random intercept cross-lagged panel models, we investigated between- and within-person associations of social isolation and loneliness with frailty. Frailty was measured using the Frailty Index. Loneliness was measured using the 11-item De Jong Gierveld Loneliness Scale. Social isolation was measured using a multi-domain 6-item scale. Results Social isolation and loneliness were weakly correlated across waves. At the between-person level, individuals with higher levels of frailty tended to have higher levels of social isolation but not loneliness. At the within-person level, the cross-lagged paths indicated that earlier frailty status predicted future social isolation and loneliness over time. However, prior social isolation was not associated with subsequent frailty except at time point 5 (T5). Loneliness at specific time points (T1, T4 and T6) predicted greater frailty at later time points (T2, T5 and T7). The results also supported reciprocal and contemporaneous relations between social isolation, loneliness and frailty. Conclusions Social isolation and loneliness are potential outcomes of frailty. Public health policies and health practitioners should prioritise interventions targeting social connection among older adults with pre-frailty or frailty.

中文翻译：

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21年来老年人虚弱、社会孤立和孤独感的时间顺序和相互关系


背景 目前尚不清楚社会孤立和孤独是否可能先于虚弱状态，或者虚弱是否会导致社会孤立和孤独。我们调查了 21 年来老年人的社会孤立、孤独和虚弱的相互关系和时间顺序。方法 我们使用了 2302 名年龄在 55 岁或以上的荷兰老年人（M = 72.6 岁，SD = 8.6，52.1% 女性）的阿姆斯特丹纵向老龄化研究的七波数据。使用随机截距交叉滞后面板模型，我们研究了社会孤立和孤独与虚弱的人与人之间和人内部的关联。使用衰弱指数来测量衰弱程度。使用包含 11 项的 De Jong Gierveld 孤独量表来测量孤独感。社会隔离是使用多领域 6 项目量表来衡量的。结果社会隔离和孤独感在各波次中呈弱相关。在人与人之间的层面上，脆弱程度较高的人往往有较高程度的社会孤立感，但孤独感却没有。在人内部层面，交叉滞后路径表明，早期的虚弱状态预示着随着时间的推移，未来的社会孤立和孤独。然而，除时间点 5 (T5) 外，先前的社会隔离与随后的虚弱无关。特定时间点（T1、T4 和 T6）的孤独感预示着稍后时间点（T2、T5 和 T7）更虚弱。研究结果还支持社会孤立、孤独和脆弱之间的互惠和同时关系。结论 社会孤立和孤独是虚弱的潜在后果。公共卫生政策和卫生从业人员应优先考虑针对虚弱前期或虚弱老年人的社会联系的干预措施。