'Social frailty' is a major dementia risk. A UNSW researcher is changing how to spot and treat it early.
Clinical psychologist Dr Suraj Samtani says when he looks at an ageing brain, he doesn't begin with memory tests or brain scans. He starts with how often someone sees a friend, joins a community activity or feels they have someone to confide in.
"Social frailty is when we are vulnerable to losing the resources we need to stay socially connected and to fulfil our social needs," says the UNSW Sydney postdoctoral research fellow at the Centre for Healthy Brain Ageing (CHeBA).
Dr Samtani's work focuses on the risk of developing dementia. He says the consequences of being socially disconnected as we get older are profound, with social frailty being linked not only to cognitive decline but higher rates of disability and early death.
"In midlife, risk factors like hearing loss and metabolic syndromes like hypertension and diabetes are very important to prevent and manage," Dr Samtani says.
"But in late life, social isolation is the biggest risk factor for dementia."
A national picture
The goal of Dr Samtani's work is to help older adults with cognitive concerns feel more confident in social situations, to feel connected and potentially improve their quality of life.
While existing treatments focus on improving memory or language within this population, there is currently no treatment that focuses on enhancing or maintaining their social skills and connections.
One of his team's key outcomes is an evidence-based index to help general practitioners screen for social frailty. This addresses a gap that he says has long hampered prevention efforts.
"We know that it's really important to screen for social frailty, which is why we're recommending this index for physicians or GPs to use, because it asks questions about social connections which are directly relevant to dementia risk," Dr Samtani says.
The research behind the tool so far draws largely from older adults living in Sydney's eastern suburbs through the long-running Sydney Memory and Ageing Study. This had 1037 participants at baseline, and many were followed up every two years for up to 12 years.
The recently published study , coauthored by Dr Samtani, followed 851 participants to see which social frailty index would best predict the risk of developing dementia.
The results show socially frail individuals were up to 50% more likely to develop dementia, even after accounting for other factors such as physical and psychological frailty.
"This suggests social frailty is not only a key risk factor, but one we can identify early and potentially change," says lead author Dr Annabel Matison, who is also a UNSW postdoctoral research fellow at CHeBA.
The findings show social frailty was a predictor even in those who were cognitively healthy at the start of the study.
But, there is more work to be done.
"We really need a more diverse population to replicate this finding before we can say 'this should be rolled out to everyone'," Dr Samtani says.
That means seeking and including data beyond Sydney's east into more socioeconomically diverse, regional and rural parts of Australia. To do this, UNSW has now established a Sydney Brain Health Equity Lab.
"We want to look at the social and structural risk factors for dementia and ask: does remoteness matter, does discrimination matter? We want to make sure that it's brain health for all - not just for some people," he says.
A world of difference
On a global scale, across 40,000 people, the data also show socially isolated people have double the risk of dementia, even after accounting for other risk factors such as alcohol consumption and physical inactivity.
Dr Samtani says though there are strong local and international results, research alone won't shift the needle. He is now leading a clinical trial , funded by the Dementia Australia Research Foundation, that aims to reduce loneliness and improve social confidence in people with memory loss or dementia.
The program Maintaining Social Engagement within the trial focuses on the social skills that many people with cognitive concerns struggle with. This includes reading body language, keeping conversations going, navigating memory challenges, managing sensory overwhelm and practising assertiveness.
The results of the pilot study show promising improvements in understanding and communicating with others.
"We have just finished running our final group, and we will soon be analysing the data," he says.
The trial partners with Silverchain , one of Australia's largest aged-care providers, and involves 57 participants aged 50+. Participants complete either the program or are part of an active control group involving online social interactions. Follow-ups occur both after the program and three months later, to determine long-term outcomes.
