Loneliness and social isolation are widely recognised as harmful to elders' health, yet frontline care workers have long lacked a simple, objective way to identify those most at risk. Researchers at The Hong Kong Polytechnic University (PolyU) have developed a set of community-based, preventive approaches to addressing social frailty among seniors, including a new screening tool and nature-based interventions in care facilities. This work responds directly to the Government's policy shift from treatment towards prevention and community-based care.
Social frailty refers to a state of vulnerability arising from a lack of social support, resources, connectedness and the fulfilment of basic needs. It is linked to poorer health and may increase the risk of physical frailty. Until now, the absence of standardised terminology and objective measurement tools has made these subjective experiences difficult to consistently assess.
To close this gap, the team led by Prof. Jed MONTAYRE, Associate Head (Strategy) and Associate Professor of the School of Nursing, developed the Social Frailty 10-Item screening tool (SF-10). Brief in design for busy clinical settings, it helps enable frontline workers to identify at-risk older adults early and direct them to appropriate help. Supported by the General Research Fund of the Research Grants Council, the study was published in Contemporary Nurse, and social workers in non-governmental organisations and community clinics have already adopted the tool.
Prof. Montayre said, "Recognising social frailty as a risk factor opens up a more holistic understanding of ageing. It positions social well-being on par with physical health, acknowledging that the two are inextricably linked and that addressing social risks can profoundly improve overall health outcomes."
In developing SF-10, the team used a co-design approach to make it both rigorous and non-stigmatising, conducting two rounds of workshops with 40 diverse stakeholders, including older adults, family caregivers, social workers, occupational therapists, nurses and doctors. 234 community-dwelling seniors were evaluated with the resulting tool, which demonstrated promising reliability and validity, with further validation currently under way.
SF-10 assesses five domains: general resources, social participation, social connections, interpersonal relationships and self-management. Each is rated on a five-point scale, with higher scores signalling greater risk. The results guide practical next steps: low scores for general resources can trigger referral to financial or healthcare support, while low social participation scores can point individuals towards community programmes or social prescribing — a holistic approach promoted by the World Health Organisation of referring people to non-medical community activities to improve their well-being.
"SF-10 serves as a practical instrument for longitudinal care tracking in fast-paced environments like primary care, community services and home-based care, providing a solid foundation for social prescribing," said Prof. Montayre. "By administering periodic screening, care networks can track how an individual's social risk profile changes over time. We hope it will eventually become a standardised assessment across Hong Kong."
In related work that reinforces the importance of social connectedness, Prof. Montayre's team also conducted a comprehensive systematic review and meta-analysis of nature-based interventions for reducing agitation in older people with dementia in care settings. Drawing on global evidence from both direct nature experiences, such as garden visits, and indirect exposures, such as circadian lighting, natural sounds or scents, it identifies physical settings and social interaction as the two critical drivers of clinical effectiveness. The relevant work is published in Healthcare.
Indoor interventions proved more effective than outdoor ones, while interventions involving social interaction outperformed those without. Notably, unregulated outdoor stimulation sometimes had negative effects, demonstrating that environmental designs must keep residents of care facilities engaged but not overwhelmed.
"Non-pharmacological measures such as nature-based interventions can enhance social well-being and help prevent social frailty, particularly among those experiencing cognitive decline," Prof. Montayre noted. "Having the space to socialise through such programmes significantly enhances social connectedness among older adults."
The findings offer practical solutions for high-density cities like Hong Kong, laying the groundwork for future dementia-friendly design guidelines. Because individuals with dementia respond differently depending on their tolerance for stimulation, Prof. Montayre stressed that environmental support must be tailored to the person.
The research team is continuing to expand validation of SF-10 and to work with community partners to translate these findings into routine practice, contributing to a more preventive, sustainable and person-oriented model of care for Hong Kong's ageing population.
