Social Relationships and Frailty in Community-Dwelling Older Adults on Hemodialysis: A Scoping Review

Life expectancy among older adults undergoing hemodialysis (HD) has increased, yet more than 70% experience physical frailty or pre-frailty before progressing to severe disability. Declines in social functioning in this population have also been associated with higher mortality risk and poorer quality of life. Despite this, relatively few studies have explored methods for evaluating social relationships and frailty among older adults receiving HD. This scoping review aimed to identify how previous studies have evaluated social relationships in this population, examine factors associated with frailty, and clarify potential research gaps. Inclusion and exclusion criteria were defined according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Participants were community-dwelling adults aged 60 years and older receiving HD. Using predefined keywords and search terms, literature searches were conducted across Cochrane Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, PsycINFO, and gray literature sources (e.g., WorldCat). This review was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry database (UMIN000055770). Twelve studies met the inclusion criteria. Frailty was assessed using physical (7 studies), multidimensional (3 studies), cognitive (1 study), and social measures (1 study). Nineteen social relationship factors were identified and categorized into three dimensions: social attributes, social activities, and social needs. However, none of the studies evaluated the appropriateness or validity of these elements for assessing social relationships among older HD patients. The findings indicate a need to validate assessment tools that integrate physical frailty and social relationship dimensions in older adults undergoing HD, which may allow earlier identification of individuals at risk of adverse outcomes.