Mediating Effect of Loneliness in the Relationship between Depressive Symptoms and Cognitive Frailty in Community-Dwelling Older Adults

Abstract

Background: This study aims to explore the mediating role of loneliness between depressive symptoms and cognitive frailty among older adults in the community. Methods: A total of 527 community-dwelling older adults aged ≥60 years were included in this cross-sectional study. A five-item geriatric depression scale was used to assess depression symptoms. Then, an eight-item University of California at Los Angeles Loneliness Scale was used to assess loneliness. Moreover, the FRAIL scale and Mini-Mental State Examination were used to assess cognitive frailty. Furthermore, regression and bootstrap analyses were used to explore the mediating role of loneliness in depression symptoms and cognitive frailty. Results: Loneliness mediates the association between depression symptoms and cognitive frailty (95% CI = 0.164~0.615), and after adjusting for loneliness, the direct effect is no longer significant (95% CI = −0.113~1.318, p = 0.099). Conclusions: Results show that the effect of cognitive frailty is not depression symptoms but loneliness. All levels of society (the government, medical institutions, and communities) need to pay more attention to the mental health of the older adults, screen for loneliness, and take timely intervention and treatment measures. They should also build an age-friendly society and promote active aging.

Institutional Residence Protects Against Cognitive Frailty: A Cross-Sectional Study

“…Loneliness has a negative impact on physical and cognitive function. 43,44 We did not observe loneliness in nursing home residents, perhaps because their daily lives were filled with effective and reasonable activities or because they remained close with their families, as shown in Figure 4.…”

Understanding exogenous factors and biological mechanisms for cognitive frailty: a multidisciplinary scoping review

“…Physical activity may be reduced by increasing PF, by reduced social engagement and by effects of depression, but any reduction in physical activity will feedback to increase PF. Hou et al (2022) suggested that although CF risk is increased 1.5 times in the presence of depression (Kwan et al, 2019) and by 75% in people who are already frail (Yuan et al, 2022), the mechanism is not yet clear. They proposed loneliness as an important mechanism, with well-established links between loneliness and frailty, and loneliness and MCI, (Fang et al, 2023; Gale, Westbury, et al, 2018; Giné-Garriga et al, 2021) and showed that loneliness may be an important mediator between depression and CF; although depression was strongly associated with CF, when loneliness was included, depression was no longer a significant predictor, 37% of the total effect of depression on CF being explained by mediation of loneliness.…”

Prevalence and modifiable risk factors of cognitive frailty in patients with chronic heart failure in China: a cross-sectional study

“…However, this study did not find evidence that depression, anxiety, or other mental states are independent factors influencing CF in CHF patients. Hou et al found that depressive symptoms do not directly affect CF in older adults, but rather, feelings of loneliness are the link between the two [ 39 ]. Loneliness can reflect social support to some extent.…”