JMIR Publications

ABSTRACT

Background:

Frail older adults are at greater risk of adverse health-related outcomes such as falls, disability, and mortality. Mild behavioral impairment (MBI), which is characterized by neurobehavioral symptoms in individuals without dementia, is a crucial factor in identifying at-risk groups and implementing early interventions for frail older adults. However, the specific role of social functioning, which encompasses social interaction and loneliness levels, in relation to frailty within this group remains unclear.

Objective:

This study investigated the association between frailty, social interaction, and loneliness levels, measured using an ecological momentary assessment approach, while adjusting for MBI symptoms in two contexts: the presence and severity of MBI symptoms among older adults with subjective cognitive decline (SCD) or mild cognitive impairment (MCI).

Methods:

Older adults with SCD or MCI were recruited from an outpatient clinic specializing in the early diagnosis of dementia and care management of dementia at a community health center, as well as from a community service center in Seoul, South Korea. Participants reported their daily social interaction frequency and loneliness level via a mobile application, four times daily for two weeks. Frailty was evaluated using the Korean version of the Frailty Phenotype Questionnaire, and MBI was assessed using a 34-item MBI-Checklist covering five domains. Multivariate logistic regression adjusted for the presence or severity of MBI symptoms was used to analyze their association with frailty.

Results:

Among the 101 participants analyzed, 42.6% were classified as frail. Higher average daily social interaction scores were consistently associated with lower odds of frailty. This was evident in the models adjusted for both the global (odds ratio [OR]: 0.51, p = .01) and domain-specific presence (OR: 0.42, p = .01) of MBI symptoms. Similar trends were observed in the models adjusted for global (OR: 0.52, p = .04) and domain-specific (OR: 0.45, p = .02) severity of MBI symptom.

Conclusions:

Frequent social interaction was inversely associated with frailty, even after adjusting for the presence and severity of MBI symptoms. This study highlights the importance of integrating behavioral and social functional assessments for the early detection, prevention, and targeted intervention for frailty in older adults with cognitive decline. Further prospective studies using real-time measurements are needed to explore the associated risk factors and comprehensive functional status of this at-risk group.