The mediating effects of social support and depressive symptoms on activities of daily living and social frailty in older patients with chronic heart failure

The multiple mediating effects of social support and depressive symptoms on the relationship between frailty and cognitive function in older patients with heart failure: A cross-sectional study

AIMS

The aim of this study was to test the multiple mediating effects of social support and depression symptoms on the relationship between frailty and cognitive function in older patients with heart failure.

METHODS AND RESULTS

We used a convenience sampling method to recruit 444 older patients with heart failure who met the inclusion criteria from a university-affiliated general hospital. Multiple mediation analyses revealed that the relationship between frailty and cognitive function was influenced by social support (effect: -0.383, 95% CI [-0.774, -0.072]) and depressive symptoms (effect: -0.349, 95% CI [-0.710, -0.134]) both individually and in tandem (effect: -0.276, 95% CI [-0.591, - 0.106]).

CONCLUSION

Social support and depressive symptoms are multiple mediators of the relationship between frailty and cognitive function. Healthcare providers should implement interventions that focus on maximizing social return and minimizing depressive symptoms to mitigate the decline in cognitive function.

Frailty and Self-Care Maintenance Mediated by Social Support and Depression in Older Adults With Heart Failure

BACKGROUND

Older adults with heart failure often exhibit poor self-care maintenance. Frailty could exacerbate self-care, leading to deteriorating health. Social support and depression may play a role in self-care maintenance in older adults with heart failure combined with frailty. Confirming this potential mechanistic relationship could provide valuable reference for nurses to formulate and improve the targeted intervention strategies and health education programs for older adults with heart failure.

OBJECTIVES

This study analyzed the relationship between frailty and self-care maintenance in older adults with heart failure and determined the sequential mediation effect of social support and depression. Its goal was to provide valuable theoretical insights for formulating targeted clinical nursing interventions for older adults with heart failure.

METHODS

A cross-sectional study was conducted from July 2023 to February 2024, during which older adults with heart failure were recruited using a convenience sampling method from the cardiovascular department of a tertiary Class A hospital in Qingdao, China. A total of 241 completed the Tilburg Frailty Indicator, the Self-Care of Heart Failure Index, the Social Support Rating Scale, and the Patient Health Questionnaire-9. t -Tests and one-way analysis of variance were used to examine differences in self-care maintenance among participants with distinct characteristics; correlation analysis was used to identify variable relationships within the study. The mediation model was tested using the SPSS PROCESS macro and the bootstrap method.

RESULTS

Frailty was negatively correlated with self-care maintenance, and both social support and depression were significantly related to frailty and self-care maintenance. Social support and depression not only independently mediated the relationship between frailty and self-care maintenance but also exhibited a significant sequential mediation effect.

DISCUSSION

The frailty of older adults with heart failure and its correlation with self-care maintenance is a complex and multidimensional phenomenon. Frailty not only directly influenced self-care maintenance in participants but also indirectly affected it through the mediating factors of social support and depression. Future research should emphasize innovative, targeted interventions to enhance social support quality and accessibility and alleviate depression, ultimately boosting patients' self-care capabilities and elevating their quality of life.

Heterogeneity of Fatigue in Patients with Chronic Heart Failure: Latent Categories and Influencing Factors

Objective

The objective of this study was to analyze the latent categories of fatigue in patients with chronic heart failure (CHF), explore their characteristic differences, and identify the associated influencing factors.

Methods

This cross-sectional study included 289 patients with CHF who were enrolled at 2 tertiary-level hospitals in Shandong, China, from August to December 2023. The convenience sampling method was used to collect data. Furthermore, the level of fatigue, insomnia, anxiety, depression, and social support were evaluated using the Chinese version of the Multidimensional Fatigue Inventory-20, Insomnia Severity Index, Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Multidimensional Scale of Perceived Social Support. Latent profile analysis was performed to elucidate the latent categories of fatigue in the patients. In addition, the risk factors associated with the different categories were assessed using multiple logistic regression analyses.

Results

The average fatigue score was 62.45 ± 13.55. The potential fatigue profile of CHF was divided into three categories: low fatigue group C1 (18.6%), moderate fatigue group C2 (47.4%), and high fatigue group C3 (34.0%). Multiple logistic regression analysis showed that C3 patients with CHF were mainly characterized by lower ejection fraction (OR = 0.01, p = 0.008), insomnia (OR = 1.19, p = 0.005), and anxiety (OR = 1.20, p = 0.034). C2 patients indicated lower ejection fraction (OR = 0.04, p = 0.040), and C1 patients had higher social support (OR = 0.91, p < 0.001; OR = 0.93, p < 0.001).

Conclusion

This study indicated that CHF patients had significantly heterogeneous levels of fatigue. Therefore, it is recommended that medical staff could adopt more precise interventions according to different category characteristics to improve the outcomes of patients with CHF.

Association between cognitive function and depressive symptoms in Chinese older adults: The mediating role of activities of daily living

OBJECTIVES

Exploring the relationship between cognitive functioning and depressive symptoms in Chinese older adults and the mediating role of the ability to perform activities of daily living.

METHODS

This study included 5775 older adults, and correlation analysis and linear regression were used to analyze the relationship between the variables and mediated effects.

RESULTS

Cognitive functioning and the ability to perform daily living significantly influenced the depressive state (β = -0.163, p < 0.01; β = 0.288, p < 0.01), and the ability to perform daily living partially mediated the effect between the two, with an effect size of 27.95%.

CONCLUSION

Cognitive function can influence depressive status through the ability to perform activities of daily living, and individualized intervention strategies should be developed for older adults to maintain or delay cognitive decline, preserve the ability to perform activities of daily living, and reduce the risk of depression.

Measuring Social Frailty: A Scoping Review of Available Scales and Tools

BACKGROUND AND OBJECTIVES

Social frailty is an emerging concept characterized by state of vulnerability due to the lack or absence of social resources that enable health and well-being, particularly among older people. However, there is no consensus on how to accurately measure and assess social frailty, given the broad coverage of social dimensions affecting older individuals. This scoping review aimed to identify the existing tools and scales used to measure social frailty in older people.

RESEARCH DESIGN AND METHODS

A scoping review methodology was employed. Articles published between January 2014 and April 2024 were searched in 6 electronic databases: PubMed, PsycINFO, ProQuest, Scopus, SocIndex, and CINAHL. The scoping review followed a 5-stage process by Arksey and O'Malley and adhered to the guidelines provided by Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews.

RESULTS

Nine social frailty tools were identified across the 58 papers included in this review. The individual question item commonly used in the scales were classified into main categories based on their conceptual characteristics and intentions. The most common individual questionnaire constructs used to measure social frailty included financial status, social resources, social behaviors and activities, and sense of purpose. The reviewed tools varied in terms of their robustness and the process of scale development.

DISCUSSION AND IMPLICATIONS

Our review suggested the development of a standardized, psychometrically tested, and accurate screening tool to screen social frailty status. An accurate social frailty assessment can inform the development of useful interventions, which also has implications in preventing the development of physical frailty.

The effect of social frailty on mental health and quality of life in older people: a cross-sectional study

PURPOSE

This study aims to evaluate anxiety, depression, loneliness, death anxiety, and quality of life and investigate their relationship with social frailty in the geriatric population. Additionally, it aimed to identify social frailty predictors.

METHODS

The study included 136 participants admitted to the geriatric outpatient clinic. The 15-item Geriatric Depression Scale (GDS-15), the Multidimensional Scale of Perceived Social Support (MSPSS), the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), the Templer Death Anxiety Scale (T-DAS), the Loneliness Scale for the Elderly (LSE), the Quality of Life Scale (CASP-19), the Generalized Anxiety Disorder-7 Test (GAD-7), the Tilburg Frailty Indicator (TFI), the FRAIL Scale, and the Clinical Frailty Scale (CFS) were performed. The TFI was used to collect data about social frailty.

RESULTS

There were 61.8% females, and the median age (min-max) was 72.2 (65.3-90.3) years. The prevalence rate of social frailty was 26.7%. The rates of depression, loneliness, anxiety, death anxiety, the burden of chronic disease, and frailty were higher in the social frailty group. Furthermore, logistic regression analysis revealed a strong relationship between social frailty status and widowhood (odds ratio (OR) 6.86; 95% confidence interval (95% CI), 2.42-19.37; p < 0.001), moderate to severe anxiety symptoms (OR 4.37; 95% CI 1.08-17.68; p = 0.038), and a TFI-physical frailty score (OR 1.40; 95% CI 1.12-1.73; p = 0.002).

CONCLUSION

In older adults, the social dimension of frailty is associated with quality of life and psychological state. Physical frailty and sociodemographic characteristics may affect the development of social frailty.