Effects of Frailty on Health-related Quality of Life of Rural Community-dwelling Elderly: Mediating and Moderating Effects of Fall-Related Efficacy and Social Support

Kyung Won Choi; Gyeong-Suk Jeon

doi:10.12799/jkachn.2016.27.4.380

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Original Article
Effects of Frailty on Health-related Quality of Life of Rural Community-dwelling Elderly: Mediating and Moderating Effects of Fall-Related Efficacy and Social Support: Kyung Won Choi, Gyeong-Suk Jeon; Journal of Korean Academy of Community Health Nursing 2016;27(4):380-387.
DOI: https://doi.org/10.12799/jkachn.2016.27.4.380
Published online: December 31, 2016

¹Department of Nursing, Korea National University of Transportation, Chungju, Korea.

²Department of Nursing, Mokpo National University, Muan, Korea.

• Received: September 26, 2016 • Revised: December 8, 2016 • Accepted: December 10, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract

Abstract

Purpose
The purpose of this study was to examine the mediating and moderating effects of fall-related efficacy and social support on the relationship between frailty and health-related quality of life among rural community-dwelling elderly.
Methods
A cross-sectional survey was conducted with a convenient sampling method, and data of 438 elderly residents living in a rural community was used. The structured questionnaire included items from the Euro Quality of life-5 Dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/ depression), fall-related efficacy and social support.
Results
Analysis of the mediating effect of fall-related efficacy and social support showed that there was significant mediating influence of fall-related efficacy on the relationship between frailty and health-related quality of life. There were no moderating effects of fall-related efficacy and social support.
Conclusion
The findings suggest that fall-related efficacy may play a role in reducing the effect of frailty on health-related quality of life and underscore the need to consider ways of enhancing fall-related efficacy in interventions for rural community-dwelling frail elderly.
Key Words: Frail elderly; Self efficacy; Social support; Quality of life

Table 1

Socioeconomic and Health Characteristics of Rural Community Dwelling Elderly (N=419)

Variables	Categories	n (%) or M±SD
Age (year)		76.25±6.77
	65~74	187 (44.6)
	75~84	183 (43.7)
	≥85	49 (11.7)
Gender (female)		340 (81.1)
Marital status (living alone)		238 (56.8)
Education	≤Elementary school	387 (92.4)
	Middle school	18 (4.3)
	≥High school	14 (3.3)
Job (yes)		123 (29.4)
Number of chronic disease		1.53±1.04
Frailty score		2.53±1.61
	Robust	209 (49.9)
	Pre-frail	162 (38.7)
	Frail	48 (11.5)
Fall related efficacy		103.64±41.02
Social support		4.97±1.87
Quality of life		0.81±0.12

Table 2

Correlations between Frailty Score, Fall related Efficacy, and Social Support of Rural Community Dwelling Elderly (N=419)

Variables	Frailty score	Fall related efficacy	Social support	Health related quality of life
Frailty score	1
Fall related efficacy	−.42^***	1
Social support	−.08^*	0.06	1
Health related quality of life	−.46^***	.54^***	.13^**	1

^*p<.05 ; ^**p<.01 ; ^***p<.001.

Table 3

Multiple Regression for Fall related Efficacy and Social Support of Rural Community Dwelling Elderly (N=419)

Variables	Frailty → Fall related efficacy	Frailty → Social support
Variables	β^†	β^†
Frailty score	−.35^***	−.10^*
Adjusted R²	.30	.01

^†Adjusted for age, gender, education, marital status, job status, number of chronic disease; ^*p<.05; ^**p<.01; ^***p<.001.

Table 4

Multiple Regression for HRQoL of Rural Community Dwelling Elderly (N=419)

Variables	Frailty→HRQoL	Fall related efficacy, Social support→HRQoL		Mediating effect		Moderating effect
Variables	Model 1 β^†	Model 2 β^†	Model 3 β^†	Model 4 β^†	Model 5 β^†	Model 6 β^†	Model 7 β^†
Fraily score	−.44^***			−.29^***	−.43^***	−.29^***	−.43^***
Fall related efficacy		.52^***		.41***		.41^***
Social support			.13^**		.10*		.09*
Frail × Fall related efficacy						−.02
Frail × Social support							.04
Sobel test (Z)				−8.34^***	−1.95
Adjusted R²	.20	.27	.07	.34	.23	.34	.23

^†Adjusted for age, gender, education, marital status, job status, number of chronic disease; ^*p<.05; ^**p<.01; ^***p<.001.

This was supported by Mokpo National University in 2012 (No. 2012-0184) and Korea National University of Transportation in 2016.

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Effects of Frailty on Health-related Quality of Life of Rural Community-dwelling Elderly: Mediating and Moderating Effects of Fall-Related Efficacy and Social Support

Variables	Categories	n (%) or M±SD
Age (year)		76.25±6.77
	65~74	187 (44.6)
	75~84	183 (43.7)
	≥85	49 (11.7)
Gender (female)		340 (81.1)
Marital status (living alone)		238 (56.8)
Education	≤Elementary school	387 (92.4)
	Middle school	18 (4.3)
	≥High school	14 (3.3)
Job (yes)		123 (29.4)
Number of chronic disease		1.53±1.04
Frailty score		2.53±1.61
	Robust	209 (49.9)
	Pre-frail	162 (38.7)
	Frail	48 (11.5)
Fall related efficacy		103.64±41.02
Social support		4.97±1.87
Quality of life		0.81±0.12

Variables	Frailty score	Fall related efficacy	Social support	Health related quality of life
Frailty score	1
Fall related efficacy	−.42^***	1
Social support	−.08^*	0.06	1
Health related quality of life	−.46^***	.54^***	.13^**	1

Variables	Frailty → Fall related efficacy	Frailty → Social support
Variables	β^†	β^†
Frailty score	−.35^***	−.10^*
Adjusted R²	.30	.01

Variables	Frailty→HRQoL	Fall related efficacy, Social support→HRQoL		Mediating effect		Moderating effect
Variables	Model 1 β^†	Model 2 β^†	Model 3 β^†	Model 4 β^†	Model 5 β^†	Model 6 β^†	Model 7 β^†
Fraily score	−.44^***			−.29^***	−.43^***	−.29^***	−.43^***
Fall related efficacy		.52^***		.41***		.41^***
Social support			.13^**		.10*		.09*
Frail × Fall related efficacy						−.02
Frail × Social support							.04
Sobel test (Z)				−8.34^***	−1.95
Adjusted R²	.20	.27	.07	.34	.23	.34	.23

Table 1 Socioeconomic and Health Characteristics of Rural Community Dwelling Elderly (N=419)

Table 2 Correlations between Frailty Score, Fall related Efficacy, and Social Support of Rural Community Dwelling Elderly (N=419)

^*p<.05 ; ^**p<.01 ; ^***p<.001.

Table 3 Multiple Regression for Fall related Efficacy and Social Support of Rural Community Dwelling Elderly (N=419)

^†Adjusted for age, gender, education, marital status, job status, number of chronic disease; ^*p<.05; ^**p<.01; ^***p<.001.

Table 4 Multiple Regression for HRQoL of Rural Community Dwelling Elderly (N=419)

^†Adjusted for age, gender, education, marital status, job status, number of chronic disease; ^*p<.05; ^**p<.01; ^***p<.001.