Frailty and Social Vulnerability.

Both intrinsic and extrinsic factors contribute to health. Intrinsic factors are familiar topics in health research and include medical conditions, medications, genetics and frailty, while extrinsic factors stem from social and physical environments. This chapter builds on others in this volume, in which a deficit accumulation approach to frailty has been described. The concept of social vulnerability is presented. Social vulnerability stems from the accumulation of multiple and varied social problems and has bidirectional importance as a risk factor for poor health outcomes and as a pragmatic consideration for health care provision and planning. Importantly, the social factors that contribute to overall social vulnerability come into play at different levels of influence (individual, family and friends, peer groups, institutions and society at large). A social ecology perspective is discussed as a useful framework for considering social vulnerability, as it allows for attention to each of these levels of influence. Tying together what we currently understand about frailty (in medical and basic science models) and social vulnerability, the scaling potential of deficit accumulation is discussed, given that deficit accumulation can be understood to occur at many levels, from the (sub-)cellular level to tissues, organisms/complex systems and societies.