The Relationship Between Health Literacy, Social Support, Depression, and Frailty Among Community-Dwelling Older Patients With Hypertension and Diabetes in China.

Yan Liu,Naidan Tu,Hongdao Meng,Danping Liu

doi:10.3389/fpubh.2020.00280

Abstract

Population aging is one of the major challenges facing modern society and has attracted global attention. With population aging becoming a global phenomenon, the impact of age-related diseases on health is increasing rapidly. Frailty is one of the most pressing issues facing older adults. The purpose of this study was to explore the interrelationship between health literacy, social support, depression, and frailty among older patients with hypertension and diabetes in China. No studies have investigated the mediating effects of social support and depression between health literacy and frailty. The findings of this study can be applied to help ameliorate frailty in older hypertensive and diabetic patients. Data were collected from 637 older hypertensive and diabetic patients aged 65 years and older in Sichuan Province, China. We used structural equation modeling (SEM) to test the hypothesized relationship among the variables. The results showed that 42.4% of the participants suffered from frailty. The mean scores for health literacy, social support, depression, and frailty were 13.6 ± 5.7, 35.7 ± 6.5, 4.0 ± 3.4, and 3.5 ± 2.1, respectively. Social support had a direct negative association with frailty (β = −0.128, 95%CI: [−0.198, −0.056]), and depression had a direct positive association with frailty (β = 0.326, 95%CI: [0.229, 0.411]), while social support had no direct association with depression. Health literacy had a direct positive association with social support (β = 0.151, 95%CI: [0.077, 0.224]) and a direct negative association with depression (β = −0.173, 95%CI: [−0.246, −0.1]), while health literacy had an indirect negative association with frailty through the mediating effect of social support and depression. To mitigate frailty in older patients with hypertension and diabetes, measures that provide social support, and enhance health literacy, while alleviating depression, should be considered, along with greater attention to patients who are divorced, widowed, or unmarried, those with comorbidities, and those with lower socioeconomic status.

Highlights

Population aging is a major challenge facing modern society and has attracted increasing global attention
The findings of this study identified the key factors that contribute to the prevention and control of frailty in older patients, which is of great significance for decreasing frailty and improving the health of older patients with hypertension and diabetes
We found that 42.4% of older hypertensive and diabetic patients suffered from frailty, which is higher than that reported for studies on the older population in Padua, Italy (21.9%) [43], and Northern Germany (41.4%) [44]

Summary

Introduction

Population aging is a major challenge facing modern society and has attracted increasing global attention. Frailty is one of the most pressing challenges facing older adults as they age [5]. In China, hypertension and diabetes affect at least 57 and 26.5% of the older population, respectively [11, 12]. The prevalence of frailty is 80% in older patients with hypertension, and is 3–5-fold higher in older patients with diabetes compared with that in those without these conditions [13, 14]. Diabetes often coexists with hypertension among older adults in China. The above findings emphasize the importance and need for concern about frailty in older patients with hypertension and diabetes within the context of a rapidly aging population

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Discussion

Conclusion