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Interactions between loneliness, social isolation and reversible cognitive frailty on falls and fall-induced injuries among community-dwelling older adults: A prospective cohort study
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DOI：10.1016/j.gerinurse.2026.104013.png)
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Abstract
En 中文
Objectives: This study aimed to explore joint effects of impoverished social relationships (loneliness and social isolation) and reversible cognitive frailty (RCF) on falls and fall-induced injuries. Methods: Data were from five waves (2011-2020) of the China Health and Retirement Longitudinal Study (CHARLS) among 2912 participants aged >= 60 years at baseline. Cox proportional hazards models were applied to explore the associations of impoverished social relationships and RCF with falls and fall-induced injuries. Results: During 9-year follow-up, 1187 (40.8 %) participants experienced falls and 587 (20.2 %) participants experienced fall-induced injuries. Participants exposed to both social isolation and RCF (HR = 1.354-1.374, 95 %CI = 1.073-1.708) had higher risk of falls and fall-induced injuries than those exposed to one factor alone (HR = 0.956-1.095 95 %CI = 0.775-1.293). There were significant additive interaction (Falls: RERI = 0.296, 95 %CI = 0.033-0.560; Fall-induced injuries: RERI = 0.400, 95 %CI = 0.044-0.755) and multiplicative interaction (Falls: P for interaction = 0.043; Fall-induced injuries: P for interaction = 0.042) between social isolation and RCF. The social isolation-stratified analyses showed that the significant association of RCF with higher risk of falls or fall-induced injuries persisted for high social isolation subgroup, but not for low social isolation subgroup. However, there were no significant interactions between loneliness and RCF on falls and fall-induced injuries. Conclusion: RCF works synergistically with social isolation but not with loneliness to induce falls and fall-induced injuries among older adults, and the detrimental effect of RCF may be offset by low social isolation but not by loneliness. These findings implicate integrate social and health care targeting social isolation and RCF to effectively prevent falls and fall-induced injuries among older adults. (c) 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Keywords:
Falls
Loneliness
Social isolation
Reversible cognitive frailty
Joint effect
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