Community-Level Social Support to Mitigate the lmpact of Combined Frailty and Multimorbidity on Psychological Distress Among Rural Chinese Older Adults: Multilevel Modeling Study During the COVID-19 Pandemic.

Abstract

Accumulating research provides evidence that the psychological health of older people deteriorated from the prior to during the COVID-19 pandemic. Unlike robust individuals, co-existing frailty and multimorbidity would expose older adults to more complicated and wide-ranging stressors. Community-level social support is also an important impetus for age-friendly interventions, and it is one of the components of social capital which is seen as an ecological-level property. To date, we did not find research that examined whether community social support buffer the adverse impact of the combined frailty and multimorbidity on psychological distress in rural setting during the COVID-19 in China. This study explores the combined effect of frailty and multimorbidity on psychological distress in rural Chinese older adults during the COVID-19 pandemic, and to examine whether community-level social support would buffer the afore-mentioned association. Data used in this study were extracted from two waves of the Shandong Rural Elderly Health Cohort (SREHC), the final analytic sample included 2,785 respondents who participated both of the baseline and follow-up surveys. Multilevel linear mixed-effects models were employed to quantify the strength of the longitudinal association between frailty and multimorbidity combinations and psychological distress using two waves of data for each participant, and then, the cross-level interactions between community-level social support and the combination of frailty and multimorbidity were included to test whether the community-level social support would buffer the adverse impact of the coexisting frailty and multimorbidity on psychological distress. Frail older adults with multimorbidity reported the most psychological distress compared with individuals with only one or without any of the conditions (β=0.68; 95% CI: 0.60 to 0.77; P<.001), and baseline coexisting frailty and multimorbidity predicted the most psychological distress during the COVID-19 pandemic (β=0.32; 95% CI: 0.22 to 0.43; P<.001). Further, community social support moderated the afore-mentioned association (β=-0.16; 95% CI: -0.23 to -0.09; P<.001), and the increased community-level social support buffered the adverse effect of coexisting frailty and multimorbidity on psychological distress during the COVID-19 pandemic (β=-0.11; 95% CI: -0.22 to -0.01; P=.035). Our findings suggest that more public health and clinical attention should be paid to psychological distress among multimorbid older adults with frailty when facing public health emergencies. This research also suggests that community-level interventions prioritizing social support mechanisms, specifically, improving the averaged levels of social support within communities, may be an effective approach to alleviate psychological distress for rural older adults who concurrently manifest frailty and multimorbidity.