Longitudinal associations and mechanisms linking frailty, depression, and self-perceptions of aging among community-dwelling older adults: a psychosomatic interaction perspective
Objective To investigate the longitudinal dynamic relationships among frailty, depression, and self-perceptions of aging in community-dwelling older adults, to analyze the mediating role of depression between frailty and aging cognition, and to provide a theoretical basis for physical and mental health interventions for this population. Methods A longitudinal follow-up research design was adopted, involving three waves of surveys (T1, T2, T3) conducted with 286 community-dwelling older adults. Assessments were performed using the Frailty Phenotype, a depression scale, and a brief version of the Self-Perceptions of Aging Scale. SPSS 26.0 was used for descriptive statistics and correlation analysis, while Mplus 8.3 was employed to construct cross-lagged panel models. Covariates such as age, gender, education level, the number of chronic diseases, and cognitive function were controlled. Results The cross-lagged panel model demonstrated good fit indices. With the exception of baseline (T1) self-perceptions of aging not significantly predicting the midterm (T2) level, all other core variables exhibited significant temporal stability. Controlling for autoregressive effects and covariates, significant bidirectional predictive relationships emerged: T1 frailty significantly predicted T2 depression, and T2 depression significantly predicted T3 frailty; T1 depression significantly predicted T2 self-perceptions of aging, and T2 self-perceptions of aging significantly predicted T3 depression. Furthermore, the direct predictive path from frailty to self-perceptions of aging was not significant, suggesting that depression may constitute an indirect pathway linking frailty and self-perceptions of aging. Conclusion This study supports a dynamic psychosomatic interaction pattern among frailty, depression, and self-perceptions of aging in community-dwelling older adults. Depression serves as a core hub connecting physiological frailty and subjective aging cognition. The findings support the Psychosomatic Interaction Theory (PIT) and Stereotype Embodiment Theory (SET). These results suggest that community nursing practice should emphasize early screening and intervention for depressive symptoms. Targeting this potentially important depressive pathway may help interrupt the adverse cycle of “physiological frailty – psychological depression - negative aging cognition” among older adults can be disrupted.