Social vulnerability underlying disability amongst older adults: A systematic review

Miriam Cappelli, Alessandro Bordonali, Chiara Giannotti, Fabrizio Montecucco, Alessio Nencioni, Patrizio Odetti, Fiammetta Monacelli

Research output: Contribution to journalReview articlepeer-review


Background: Older adults face radical changes in their social life during ageing, dealing with several age-related social adaptations. The aim of this review is to systematically explore the literature on social vulnerability (SV) and its association with functional decline activity of daily living (ADL)/instrumental activities of daily living (IADL) as an endpoint in older adults. Methods: We searched for relevant studies in three different databases: PubMed, Ovid Medline and PsychInfo. Inclusion criteria included: prospective cohort studies assessing SV correlation; studies in English, Italian, French and Spanish to the end of March 2018; a general population aged >65 years living in a community setting and/or studies including younger participants if the mean age was >65 years; and basic ADL and/or IADL by Katz and Lawton, respectively, as functional decline and clinical outcomes. Results: We identified 65 manuscripts that assessed the role of SV in functional decline. Our systematic analysis showed that 26, 36 and 19 studies observed a correlation between Basic Social Needs, Social Resources and Social Behaviour and Activity, respectively, and the onset of ADL/IADL functional decline. Twenty-six studies explored the correlation between General Social Resources and the onset of ADL/IADL functional decline. Conclusions: When examining a wide set of social variables, the “quality,” rather than just structure, and “type” of social relationship represents the core feature of SV that predicts functional decline in older adults. By defining individual SV, its measurement and evaluation, we can plan effective social interventions aimed at preventing or delaying functional decline or death.

Original languageEnglish
Article numbere13239
JournalEuropean Journal of Clinical Investigation
Issue number6
Publication statusPublished - Jun 1 2020


  • frailty
  • functional decline
  • older adults
  • social vulnerability

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry


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