Characterization of social frailty in survivors of sepsis: a multicenter qualitative investigation

OBJECTIVE: Social frailty is a concept emerging in the older adult literature; it describes a progressive state of vulnerability characterized by a loss of the resources needed to fulfill basic social needs. Social frailty and vulnerability are known to negatively affect physical outcomes and mortality, resulting in higher health care costs and resource use. Social frailty after acute and critical illness has not been described and might be an important mechanism that prevents full recovery. Using multicenter qualitative data, we sought to establish if social frailty was important during recovery from sepsis and characterize its features. METHODS AND ANALYSIS: We undertook in-depth interviews with sepsis survivors, their family members, and clinicians from across the United Kingdom. Interviews took place virtually, and data analysis was underpinned by the framework method. RESULTS: Across the 3 groups, 44 participants were interviewed, including 11 (25.0%) clinicians, 27 (61.4%) survivors, and 6 (13.6%) family members. Social frailty appeared to be important during recovery and was characterized by 4 major concepts: financial insecurity, social interactions, ongoing treatment-related issues (treatment burden), and family and relationship challenges (social resources). The mechanisms that appeared to drive social frailty were both related to the illness pathway and the provision or lack of health and social care services. Importantly, we found that new or worsening physical frailty following critical illness appeared to worsen social frailty; similarly, social frailty appeared to have a negative influence on physical and mental health outcomes. CONCLUSION: This qualitative analysis of multiperspective data has characterized the key features of social frailty in survivors of sepsis. Future research should explore how social frailty could be managed across the recovery trajectory, including how services could be implemented in clinical practice.