The Mediating Role of Activities of Daily Living in the Relationship Between Depressive Symptoms and Multidimensional Frailty in the Elderly with Multimorbidity

Previous studies have shown an association between depression and frailty in older adults, but the psychological and social dimensions of frailty are often overlooked, especially in the context of multimorbidity. This study aims to explore the association of depressive symptoms with multidimensional frailty and the mediating role of ADL. Data were collected using a general information questionnaire, Tilburg Frailty Indicator (TFI), ADL was assessed with Barthel index, and Elderly Depression Rating Scale. Depressive symptoms were significantly correlated with multidimensional frailty (including each dimension) and ADL (p <0.05). Regression analysis showed that depressive symptoms were directly associated with multidimensional frailty (β = 0.484, p < 0.001) and indirectly through ADL (β = 0.442, p < 0.001). Dimensions showed that depressive symptoms directly associated with physical frailty and mental frailty (β = 0.454, 0.542, 0.118, p < 0.001) indirectly through ADLs (β = 0.250, 0.492, p < 0.001). Bootstrap tests confirmed the robustness of these findings. The findings confirm the importance of interventions targeting mental health and restoration of physical function to prevent multidimensional frailty in older adults with multimorbidity.