ORIGINAL ARTICLE

Exploring the chain mediating roles of frailty and depressive symptoms in the relationship between pain and cognitive function among nursing home older adults

Corresponding Author

Xia Zhao

[email protected]

orcid.org/0000-0001-8742-5244

Department of Health Management, Heze Medical College, Heze, China

Correspondence: Ms. Xia Zhao, MD, Department of Health Management, Heze Medical College, 1950 Daxue Road, Heze, Shandong, China. Email: [email protected]

Search for more papers by this author

Huaxin Si,

Huaxin Si

School of Public Health, Peking University, Beijing, China

Search for more papers by this author

Xia Zhao,

Corresponding Author

Xia Zhao

[email protected]

orcid.org/0000-0001-8742-5244

Department of Health Management, Heze Medical College, Heze, China

Correspondence: Ms. Xia Zhao, MD, Department of Health Management, Heze Medical College, 1950 Daxue Road, Heze, Shandong, China. Email: [email protected]

Search for more papers by this author

Huaxin Si,

Huaxin Si

School of Public Health, Peking University, Beijing, China

Search for more papers by this author

First published: 07 February 2024

https://doi.org/10.1111/psyg.13089

Disclosure: The authors declare no conflict of interest.

Share a link

Email
Wechat
Bluesky

Abstract

Background

The prevalence of cognitive decline is high among nursing home older adults. Pain is a vital factor in cognitive function. Furthermore, the current literature lacks the complex association between pain, frailty, depressive symptoms, and cognitive function. The aim of this study was to explore the chain mediating roles of frailty and depressive symptoms in the association between pain and cognitive function among nursing home older adults.

Methods

This is a population-based cross-sectional study, conducted in China, of 210 nursing home older adults aged 64–98 years old, who completed the measurements of sociodemographic information, pain, frailty, depressive symptoms, and cognitive function. Mediation analyses tested the indirect effect of frailty and depressive symptoms in the relationship between pain and cognitive function by PROCESS macro.

Results

Pain, frailty, as well as depressive symptoms, were negatively related to cognitive function. Frailty mediated the association between pain and cognitive function. Importantly, mediation analyses showed that frailty and depressive symptoms acted as sequential mediators of pain and cognitive function.

Conclusions

These findings have crucial clinical implications, as they suggest targeting physiological and psychological factors in older adults with chronic pain to alleviate cognitive decline.

Open Research

DATA AVAILABILITY STATEMENT

Research data are not shared.

REFERENCES

1Statistics NBO. Statistical Bulletin of the People's Republic of China on National Economic and Social Development for 2022, 2023. from https://www.gov.cn/xinwen/2023-02/28/content_5743623.htm.
Google Scholar
2Chen J, Wang X, Xu Z. The relationship between chronic pain and cognitive impairment in the elderly: a review of current evidence. J Pain Res 2023; 16: 2309–2319.
10.2147/JPR.S416253
CAS PubMed Web of Science® Google Scholar
3Cravello L, Di Santo S, Varrassi G et al. Chronic pain in the elderly with cognitive decline: a narrative review. Pain Ther 2019; 8: 53–65.
10.1007/s40122-019-0111-7
PubMed Web of Science® Google Scholar
4Heled E, Aloni R, Achiron A. Cognitive functions and disability progression in relapsing-remitting multiple sclerosis: a longitudinal study. Appl Neuropsychol Adult 2021; 28: 210–219.
10.1080/23279095.2019.1624260
PubMed Web of Science® Google Scholar
5Kohler IV, Ciancio A, Kampfen F et al. Pain is widespread and predicts poor mental health among older adults in rural Malawi. Innov Aging 2022; 6: c8.
10.1093/geroni/igac008
Google Scholar
6van Dalen-Kok AH, Pieper M, de Waal M et al. The impact of pain on the course of ADL functioning in patients with dementia. Age Ageing 2021; 50: 906–913.
10.1093/ageing/afaa247
PubMed Web of Science® Google Scholar
7Tian X, Wang C, Qiao X et al. Association between pain and frailty among Chinese community-dwelling older adults: depression as a mediator and its interaction with pain. Pain 2018; 159: 306–313.
10.1097/j.pain.0000000000001105
PubMed Web of Science® Google Scholar
8Takai Y, Yamamoto-Mitani N, Okamoto Y, Koyama K, Honda A. Literature review of pain prevalence among older residents of nursing homes. Pain Manag Nurs 2010; 11: 209–223.
10.1016/j.pmn.2010.08.006
PubMed Web of Science® Google Scholar
9van der Leeuw G, Eggermont LH, Shi L et al. Pain and cognitive function among older adults living in the community. J Gerontol A Biol Sci Med Sci 2016; 71: 398–405.
10.1093/gerona/glv166
PubMed Web of Science® Google Scholar
10Bell TR, Sprague BN, Ross LA. Longitudinal associations of pain and cognitive decline in community-dwelling older adults. Psychol Aging 2022; 37: 715–730.
10.1037/pag0000699
PubMed Web of Science® Google Scholar
11Oyon J, Serra-Prat M, Limon E et al. Depressive symptom severity is a major risk factor for frailty in community-dwelling older adults with depression. A prospective study. Fam Pract 2022; 39: 875–882.
10.1093/fampra/cmab174
PubMed Web of Science® Google Scholar
12Tse MMY, Lai C, Lui JYW. Frailty, pain and psychological variables among older adults living in Hong Kong nursing homes: can we do better to address multimorbidities? J Psychiatr Ment Health Nurs 2016; 23: 303–311.
10.1111/jpm.12303
CAS PubMed Web of Science® Google Scholar
13Xiong J, Xue WX. The role of vitamin D in the link between physical frailty and cognitive function: a mediation analysis in community-dwelling Chinese older adults. Front Nutr 2022; 9: 922673.
10.3389/fnut.2022.922673
PubMed Web of Science® Google Scholar
14Zhao X, Si H. Loneliness and frailty among nursing home older adults: the multiple mediating role of social support and resilience. Psychogeriatrics 2021; 21: 902–909.
10.1111/psyg.12765
PubMed Web of Science® Google Scholar
15Miyamura K, Fhon J, Bueno AA et al. Frailty syndrome and cognitive impairment in older adults: systematic review of the literature. Rev Lat Am Enfermagem 2019; 27: e3202.
10.1590/1518-8345.3189.3202
PubMed Web of Science® Google Scholar
16Li CL, Chang HY, Stanaway FF. Combined effects of frailty status and cognitive impairment on health-related quality of life among community dwelling older adults. Arch Gerontol Geriatr 2020; 87: 103999.
10.1016/j.archger.2019.103999
PubMed Web of Science® Google Scholar
17Zhao M, Zhu Y, Hu M, Chen Y, Xie L. Mediating effect of frailty between nutrition and cognitive function among elderly patients. Military Nurs 2023; 40: 15–18.
Google Scholar
18Zhao X, Zhang D, Wu M et al. Loneliness and depression symptoms among the elderly in nursing homes: a moderated mediation model of resilience and social support. Psychiatry Res 2018; 268: 143–151.
10.1016/j.psychres.2018.07.011
PubMed Web of Science® Google Scholar
19Desai R, Charlesworth GM, Brooker HJ et al. Temporal relationship between depressive symptoms and cognition in mid and late life: a longitudinal cohort study. J Am Med Dir Assoc 2020; 21: 1108–1113.
10.1016/j.jamda.2020.01.106
PubMed Web of Science® Google Scholar
20Ma W, Wu B, Gao X, Zhong R. Association between frailty and cognitive function in older Chinese people: a moderated mediation of social relationships and depressive symptoms. J Affect Disord 2022; 316: 223–232.
10.1016/j.jad.2022.08.032
PubMed Web of Science® Google Scholar
21Resciniti NV, Farina MP, Merchant AT, Lohman MC. Depressive symptoms partially mediate the Association of Frailty Phenotype Symptoms and Cognition for females but not males. J Aging Health 2023; 35: 42–49.
10.1177/08982643221100688
PubMed Web of Science® Google Scholar
22Currenti W, Godos J, Alanazi AM et al. Dietary fats and cognitive status in Italian middle-old adults. Nutrients 2023; 15: 1–11.
Web of Science® Google Scholar
23Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 1975; 23: 433–441.
10.1111/j.1532-5415.1975.tb00927.x
CAS PubMed Web of Science® Google Scholar
24Lee YC, Lin YT, Chiu EC. A comparison of test-retest reliability of four cognitive screening tools in people with dementia. Disabil Rehabil 2022; 44: 4090–4095.
10.1080/09638288.2021.1891466
PubMed Web of Science® Google Scholar
25Zhao X, Zhang D, Wu M et al. Depressive symptoms mediate the association between insomnia symptoms and health-related quality of life and synergistically interact with insomnia symptoms in older adults in nursing homes. Psychogeriatrics 2019; 19: 584–590.
10.1111/psyg.12441
PubMed Web of Science® Google Scholar
26Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging 2012; 16: 601–608.
10.1007/s12603-012-0084-2
CAS PubMed Web of Science® Google Scholar
27Drageset J, Eide GE, Ranhoff AH. Anxiety and depression among nursing home residents without cognitive impairment. Scand J Caring Sci 2013; 27: 872–881.
10.1111/j.1471-6712.2012.01095.x
PubMed Web of Science® Google Scholar
28Eccleston C, Crombez G. Pain demands attention: a cognitive-affective model of the interruptive function of pain. Psychol Bull 1999; 125: 356–366.
10.1037/0033-2909.125.3.356
CAS PubMed Web of Science® Google Scholar
29D'Agnelli S, Amodeo G, Franchi S et al. Frailty and pain, human studies and animal models. Ageing Res Rev 2022; 73: 101515.
10.1016/j.arr.2021.101515
PubMed Web of Science® Google Scholar
30Shega JW, Dale W, Andrew M, Paice J, Rockwood K, Weiner DK. Persistent pain and frailty: a case for homeostenosis. J Am Geriatr Soc 2012; 60: 113–117.
10.1111/j.1532-5415.2011.03769.x
PubMed Web of Science® Google Scholar
31Ormel J, Rijsdijk FV, Sullivan M, van Sonderen E, Kempen GI. Temporal and reciprocal relationship between IADL/ADL disability and depressive symptoms in late life. J Gerontol B Psychol Sci Soc Sci 2002; 57: P338–P347.
10.1093/geronb/57.4.P338
PubMed Web of Science® Google Scholar
32Jorm AF. Is depression a risk factor for dementia or cognitive decline? A review. Gerontology 2000; 46: 219–227.
10.1159/000022163
CAS PubMed Web of Science® Google Scholar
33Almeida OP, Hankey GJ, Yeap BB, Golledge J, Flicker L. Depression as a modifiable factor to decrease the risk of dementia. Transl Psychiatry 2017; 7: e1117.
10.1038/tp.2017.90
CAS PubMed Web of Science® Google Scholar
34Xu J. Application Research on the Effect of Heat-Sensitive Moxibustion Combined with Exercise on Frailty with Knee Osteoarthritis. Nanchang: Nanchang University, 2022.
Google Scholar
35Li Z. Taijiquan Combined with Resistance Training on the Application of Frailty in Pension Institutions. Zhenjiang: Jiangsu University, 2021.
Google Scholar
36Hou X. Research of the Application of Baduanjin in Institutional Elderly Frailty. Chengdu: Chengdu University of TCM, 2018.
Google Scholar
37Bai Z, Li W, Song M et al. Effect of different psychological interventions on depressive symptoms of the elderly in pension institutions: a net-work meta analysis. J Nurs Admin 2022; 22: 632–638.
Google Scholar

Volume24, Issue2

March 2024

Pages 426-432

Exploring the chain mediating roles of frailty and depressive symptoms in the relationship between pain and cognitive function among nursing home older adults

Abstract

Background

Methods

Results

Conclusions

Open Research

DATA AVAILABILITY STATEMENT

REFERENCES

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Exploring the chain mediating roles of frailty and depressive symptoms in the relationship between pain and cognitive function among nursing home older adults

Abstract

Background

Methods

Results

Conclusions

Open Research

DATA AVAILABILITY STATEMENT

REFERENCES

References

Related

Information