Social Frailty Is Associated with Assistance Seeking and Long-Term Care Insurance (LTCI) Utilization of Older Adult

Background and Purpose:Having access to social resources increases the possibility of fulfilling multiple social needs, which is essential to maintain a moderate level of quality of life for older adults. Receiving appropriate timely assistance and long-term care insurance (LTCI) often shows high association with older adults’ ability to obtain information or resources. Social frailty can be defined as a level of risk of losing or having lost significant resources for the fulfillment of one or more basic social needs during one’s lifetime.

The purpose of this study is to confirm the level of assistance and extent of LTCI utilization needed among socially frail older adults; the research also analyzes the association of these resources with social frailty status among participants who are not receiving (or could not receive) appropriate assistance and those who did not (or could not) apply for LTCI.

Methods:Data and Samples:The data are from a 2017 National Survey of Older Koreans (N=9,805, Mean age=73.79±6.52, 57% female).

Measures:Social frailty was assessed according to four criteria: absence of economic resources, absence of social resources, absence of social activities, and absence of social interactions. The score ranges from 0 to 4, with each component worth 1 point. Social frailty status was measured and categorized as follows: 0 to 1 is considered socially robust, and 2 or more is socially frail. Activities of Daily Living (ADL) disability and Instrumental Activities of Daily Living (IADLs) disability were measured when participants answered that they are dependent on any of the items in the score.

Results:The prevalence of social frailty in population was 35.4 percent (p<.001). Approximately 11.4% of socially frail older adults have an ADL disability and 36.5% have an IADL disability, while 3.6% and 14% of socially healthy older adults have an ADL or IADL disability, respectively (p<.001). Among older adults with either disability, the percentage of socially frail older adults was 60%. Among older adults who are not receiving assistance, those who are socially frail are more likely than their socially healthy counterparts to respond that they “need help but there’s no one to help me” (odds ratio [OR] 2.53, 95% confidence interval [CI], 1.65–3.88). Among people who did not apply for LTCI, more socially frail older adults stated that they are “unaware of long-term care insurance for the elderly” (OR 1.60, CI 1.35–1.90), “in ill health but felt that grade accreditation wouldn’t be given” (OR 1.82, CI 1.56–2.12), and “thought that the cost would be a burden” (OR 2.61, CI 1.76–3.88).

Conclusion and Implications:Through the exploration of the substantial support needs of socially frail older adults and the association between the utilization of assistance and LTCI, this study highlights several comprehensive implications: socially frail older adults are less likely (by choice or inability) to apply for LTCI, as they may be unaware of the services due to the lack of resources available at the economic, social and community levels. This study identifies the marginalized population who are in need, and the reasons for low accessibility of assistance and LTCI.