The moderating effect of frailty on the network of depression, anxiety, and loneliness in community-dwelling older adults

Objectives: Comorbidities of depression, anxiety and loneliness may be more prevalent in frail older adults, which may lead to an accelerated deterioration of psychological symptoms. This study was aimed to assess the moderating effect of frailty on the network of depression, anxiety, and loneliness symptoms in communitydwelling older adults. Methods: A sample of 4253 older adults were recruited from the Psychology and Behavior Investigation of Chinese Residents (PBICR). Frailty, depression, anxiety, and loneliness were assessed using the FRAIL scale, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder 7-item scale, and the Three-Item Loneliness Scale, respectively. Covariates of age, gender, education level, living status, marital status, and monthly family income were also collected. Results: The prevalence of combined depression, anxiety and loneliness was 36.49 % in (pre)frail (i.e., frail or prefrail) older adults. Using the moderated network model, we found that (pre)frail older adults were more likely to experience "sad mood", "appetite changes", and "feel left out" than non-frail older adults. In addition, (pre) frail older adults had stronger correlations between "feel left out" and "feel isolated from others", "feel isolated from others" and "lack companionship", "nervousness or anxiety" and "feel left out", "nervousness or anxiety" and "feel isolated from others", and "sleep difficulties" and "feel left out" than non-frail older adults, while nonfrail older adults had stronger correlations between "feel worthlessness" and "psychomotor agitation/retardation" than (pre)frail older adults. Conclusions: (Pre)frail older adults may experience more comorbidities of depression, anxiety and loneliness due to more symptoms and stronger correlations between specific symptoms in the network. Future studies should target these symptoms to eliminate comorbidities of depression, anxiety and loneliness in (pre)frail older adults.