PUMPING IRONY: The Disease of Disconnection

I got a phone call out of the blue the other day from an old colleague and pal who had vanished from my ever-dwindling social circle a couple of years ago. The Cap’n had moved to the East Coast to be closer to his kids and grandkids after his wife had died, and I’d dropped off his radar just as he’d dropped off mine. Now here he was on the phone, making small talk like we’d just sat down for coffee, and promising to look me up later this spring when he planned to be back in town.

He’s turning 80 next month, he told me, and his heart has been malfunctioning, so part of me wondered whether he was reaching out like some aging rock star on a farewell concert tour. It felt good to reconnect — he’s one of my favorite people — but it served as yet another reminder of how deeply into a hermitic state I’ve descended in recent years. I could blame the pandemic, which rewarded all my cocooning tendencies, but ask any of my friends or family and they’ll tell you that the plague didn’t make me any less sociable than normal. I didn’t reach out much before COVID; I don’t reach out much now.

That’s not to say I avoid social contact altogether. Wednesday afternoons on the golf course with my brother and our pal The Commissioner is pretty much sacred during the warmer months; I’ve recently rejoined them and other friends for the monthly poker game that had been scuttled during the pandemic; and I cherish the Sunday afternoon visits from our grandson. But my social interactions have narrowed considerably over the past decade, and I’m beginning to wonder whether I may be heading toward what researchers are now calling “social frailty.”

Just as those seniors struggling with physical frailty lack resilience when recovering from an injury or ailment, the socially frail often find themselves without adequate resources when faced with challenges beyond their personal control. In both cases, those deficits can lead to health problems, but researchers have only recently begun to explore the social side of the coin.

As Judith Graham reports in Kaiser Health News, researchers in November released the results of a study suggesting that social frailty may be more common than other forms of frailty. Their review of multiple studies, involving nearly 84,000 participants in Japan, China, Korea, and Europe, found that almost one in four adults over 60 suffered from social frailty, compared with 12 percent who were physically frail and 9 percent who were cognitively frail.

More recently, research teams at Massachusetts General Hospital and the University of California, San Francisco in February published a social-frailty index to help physicians determine the social health of their patients in an effort to improve their human connections. When they tested their index against data from the Health and Retirement Study, they found that it accurately predicted a higher risk of death among 8,250 socially frail seniors during a six-year period.

Along with age and gender, the index uses eight other variables to measure your risk of social frailty:

• Neighborhood cleanliness
• Perceived control over one’s financial situation
• Meeting with children less than yearly
• Not working for pay
• Active with children
• Volunteering
• Feeling isolated
• Being treated with less courtesy and respect

“Our goal is to help clinicians identify older patients who are socially frail and to prompt problem-solving designed to help them cope with various challenges,” study coauthor Sachin Shah, MD, MPH, a physician investigator at Massachusetts General Hospital, tells Graham.

That may be a tall order for overburdened primary-care physicians who are trained to look for physical symptoms of illness rather than something as nuanced as the gaps in a patient’s social calendar. Geriatricians, on the other hand, could find Shah’s index to be a vital tool in their more socially attuned toolbox. “I can see a social frailty index being useful in identifying older adults who need extra assistance and directing them to community resources,” notes University of Southern California gerontologist Jennifer Ailshire, PhD.

Graham points to Oak Street Health, a chain of primary-care clinics for older adults, as a leader in this field. Patients are surveyed at least three times a year about issues ranging from social isolation and food insecurity to financial strains and personal safety. Combining this information with the patient’s medical data, the clinic creates a “global risk assessment” that determines the patient’s relative health risks. Based on that risk level, clinicians offer specific wellness plans, including strategies to address social issues.

The focus, says Ali Khan, MD, Oak Street’s chief medical officer of value-based care strategy, is on enhancing the patient’s ability to “continue down a path of resilience in the face of a very complicated healthcare system.”

While I suspect it will take some time before this sort of holistic approach to senior care becomes standard operating procedure at most clinics, I also remind myself to avoid projecting future troubles that don’t currently exist. My path of resilience, as Khan puts it, seems fairly clear at the moment, and what little I know about Shah’s social frailty index presents few immediate hurdles. Our neighborhood is tidy, I’m still gainfully employed, our kids (and grandkid) grace us with their presence periodically, and the only time I feel disrespected is when the cat ignores my pleas to vacate the dining room table.

Could I get out more? Sure. Could I initiate more contact? Probably. But as The Cap’n and any of my other friends or family members will tell you, I’ll always pick up the phone when they call. And that conversation may even lead to a get-together — unless I’m already booked.

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