The role of social frailty evaluation in the comprehensive geriatric assessment. Italian adaptation of the Social Vulnerability Index

The evaluation of Frailty represents a fundamental result and scope of the comprehensive geriatric assessment (CGA). Social frailty, a social situation that predisposes individuals to physical, mental, psychological, and functional issues, alongside physical and psychological frailty, is a key component of overall frailty and is particularly important to consider in older adults due to its significant impact on health outcomes. Despite the rather high prevalence of social frailty, the literature on this topic is much less extensive compared to that on physical and cognitive frailty, with a lack of consensus even on how to measure it, as it is a complex and multidimensional concept. Aim of my study is to use an Italian adaptation of the Social Vulnerability Index (SVI-I) to assess social frailty in elderly subjects enrolled in two different care settings. Furthermore, the possible association of SVI-I with frailty and other indices included in the comprehensive geriatric assessment was evaluated. This single-center, cross-sectional, observational study enrolled geriatric patients of the Geriatric Department of Pisa. All patients underwent collection of demographic data and medical history, and CGA. Frailty was assessed with two different indices: the Clinical Frailty Scale (CFS) and the Multidimensional Prognostic Index (MPI). The Italian adaptation of the SVI (SVI-I) was developed by a multicentre project aimed at translating the original version, creating and adapting it, through a Delphi consensus procedure, to our Country’s reality. The operationalization of the SVI-I was performed by assigning a score of 0 when social deficit is absent and 1 when it is present; for non-dichotomous questions, a score of 0.5 was assigned for intermediate responses. The total SVI-I score was calculated in two ways: as a raw and as a normalized score. 51 patients were enrolled (49.02% women, mean age 80.65 (6.86) years). Patients demonstrated a good degree of functional independence. Frailty was low, as measured by CFS as well as the MPI. A moderate level of comorbidity was observed. Regarding the SVI-I, we found a mean value of 13.28 (3.48) and a mean SVI-I ratio value of 0.35 (0.09). All participants exhibited some degree of social vulnerability, with SVI-I scores ranging from 4.5 to 20. As with other sample characteristics, there were no significant differences in SVI-I scores between outpatients and inpatients. No significant correlations were observed between the SVI-I and any of the examined variables. Individual SVI-I item responses were analysed to identify areas of greatest social deficit. Our data indicate that social vulnerability, while a component of frailty, is a distinct condition that can significantly precede physical and/or psychological frailty. The SVI-I is a promising new tool for addressing social frailty. The SVI-I's value lies in its wide applicability and its ability to identify specific deficits, allowing for targeted interventions at both the individual and population levels through policies designed to mitigate social frailty and its associated outcomes.