Frailty and self-neglect among rural older adults in China: indirect associations involving depressive symptoms and social support

Elder self-neglect (ESN) is an important public health issue associated with adverse health outcomes among older adults. Frailty has been identified as being significantly associated with ESN; however, the psychological and social mechanisms underlying this relationship remain insufficiently understood. This study aimed to examine whether depressive symptoms and social support statistically accounted for part of the association between frailty and ESN among rural older adults in China. A cross-sectional study was conducted among 691 rural older adults in Gansu Province, China, between December 2025 and March 2026. ESN was assessed using the Scale of the Elderly Self-Neglect (SES), frailty using Fried’s frailty phenotype, depressive symptoms using the 15-item Geriatric Depression Scale (GDS-15), and social support using the Social Support Rating Scale (SSRS). Correlation analyses and parallel mediation analyses were performed using Hayes’ PROCESS macro (Model 4) with 5,000 bootstrap resamples. Among the 691 participants, 26.8% exhibited self-neglect. Frailty was significantly associated with increased self-neglect ( r = 0.483, p < 0.01). Bootstrap analyses indicated statistically significant indirect associations between frailty and self-neglect through depressive symptoms and social support. The total indirect effect accounted for 24.91% of the total effect. Depressive symptoms had a numerically larger indirect effect (0.8253) than social support (0.0737). The direct effect of frailty remained statistically significant, accounting for 75.09% of the total effect. Among rural older adults in Gansu Province, greater frailty was associated with higher self-neglect scores, while depressive symptoms and social support showed indirect associations between frailty and self-neglect. These findings highlight the potential relevance of addressing frailty and depressive symptoms in understanding self-neglect among rural older adults in this region.