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

Articles

Page Path: HOME > J Korean Acad Community Health Nurs > Volume 27(4); 2016 > Article

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.

prev next

2,068 Views
12 Download
6 Crossref

Full Article

Download PDF

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.

1. Borgaonkar MR, Irvine EJ. Quality of life measurement in gastrointestinal and liver disorders. Gut. 2000;47(3):444–454.Article PubMed PMC
2. Centers for Disease Control and Prevention. Measuring healthy days: Population assessment of health-related quality of life. Georgia: Centers for Disease Control and Prevention; 2000. p. 40.
3. Wong TH, Nguyen HV, Chiu MT, Chow KY, Ong MEH, Lim GH, et al. The low fall as a surrogate marker of frailty predicts long-term mortality in older trauma patients. PLoS ONE. 2015;10(9):e0137127.Article PubMed PMC
4. Abellan van Kan G, Rolland Y, Bergman H, Morley JE, Kritchevsky SB, Vellas B. The I.A.N.A task force on frailty assessment of older people in clinical practice. J Nutr Health Aging. 2008;12(1):29–37.Article PubMed PDF
5. Bergman H, Ferrucci L, Guralnik J, Hogan DB, Hummel S, Karunananthan S, et al. Frailty; An emerging research and clinical paradigm: Issues and controversies. J Gerontol A Biol Sci Med Sci. 2007;6(7):731–737.Article
6. Jeon GS, Cho SH. Prevalence and social correlates of frailty among rural community-dwelling older adults. J Korean Geriatr Soc. 2014;18(3):143–152.Article
7. Masel MC, Ostir GV, Ottenbacher KJ. Frailty, mortality and health related quality of life in older Mexican Americans. J Am Geriatr Soc. 2010;58(11):2149–2153.Article PubMed PMC
8. Masel MC, Graham JE, Reistetter TA, Markides KS, Ottenbacher KJ. Frailty and health related quality of life in older Mexican Americans. Health Qual Life Outcomes. 2009;7:70.Article PubMed PMC PDF
9. Kim SY, Sohn S. Factors related to health related quality of life in rural elderly women. J Korean Gerontol Nurs. 2012;14(2):91–98.
10. Stretton CM, Latham NK, Carter KN, Lee AC, Anderson CS. Determinants of physical health in frail older people: The importance of self-efficacy. Clin Rehabil. 2006;20(4):357–366.Article PubMed PDF
11. Lee H, Cho SH, Kim JH, Kim YK, Choo HI. Influence of self efficacy, social support and sense of community on health-related quality of life for middle-aged and elderly residents living in a rural community. J Korean Acad Nurs. 2014;44(6):608–616.Article PubMed PDF
12. Tinetti ME, Mendes de Leon CF, Doucette JT, Baker DI. Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. J Gerontol. 1994;49(3):M140–M147.Article PubMed
13. Garcia EL, Banegas JR, Perez-Regadera AG, Cabrera RH, Rodriguez-Artalejo F. Social network and health-related quality of life in older adults; A population-based study in Spain. Qual Life Res. 2005;14(2):511–520.Article PubMed PDF
14. Ma L, Li Y, Wang J, Zhu H, Yang W, Cao R, et al. Quality of life is related to social support in elderly osteoporosis patients in a chinese population. PLoS One. 2015;10(6):e0127849.Article PubMed PMC
15. Jeon GS, Park SJ, Jang SN. The relationship between frailty and health-related quality of life among Korean elderly. J Korean Geriatr Soc. 2012;16(4):175–183.Article
16. Statistics Korea. 2015 Population and housing census [internet] Seoul: Statistics Korea; 2016;cited 2016 September 15. Available from: http://kostat.go.kr/portal/korea/kor_nw/2/1/index.board?bmode=read&aSeq=356061
17. Statistics Korea. 2010 Population and housing census [internet] Seoul: Statistics Korea; 2011;cited 2016 September 15. Available from: http://kostat.go.kr/portal/korea/kor_nw/2/1/index.board?bmoderead&aSeq=247687
18. Kim DJ, Yoon SM, Lee SH, Na BJ, Park JH. Community resources organization plan for the health promotion of rural and fishery inhabitants. Research Report. Seoul: Korea Institute for Health and Social Affairs; 2012. 11;Report No.: 978-89-8187-000-0 93510.
19. Hwang HS, Kwon IS, Park BJ, Cho B, Yoon JL, Won CW. The validity and reliability of Korean frailty index. J Korean Geriatr Soc. 2010;14(4):191–202.Article
20. Greenberg SA. How to try this; The geriatric depression scale: Short form. Am J Nurs. 2007;107(10):60–69.
21. Powell LE, Myers AM. The activities-specific balance confidence (ABC) scale. J Gerontol A Biol Sci Med Sci. 1995;50A(1):M28–M34.Article PubMed
22. Jang SN, Cho SI, Ou SW, Lee ES, Baik HW. The validity and reliability of Korean fall efficacy scale (FES) and activities-specific balance confidence scale (ABC). J Korean Geriatr Soc. 2003;7(4):255–268.
23. Mitchell PH, Powell L, Blumenthal J, Norten J, Ironson G, Pitula CR, et al. A short social support measure for patients recovering from myocardial infarction: The ENRICHD Social Support Inventory. J Cardiopulm Rehabil. 2003;23(6):398–403.PubMed
24. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173–1182. Article PubMed
25. Moon SS, Nam JJ. Health status of elderly in Korea: Focus on physical health and disability of elderly women. J Korean Gerontol Soc. 2001;21(1):15–29.
26. Kim JY, Lee SG, Lee SK. The relationship between health behaviors, health status, activities of daily living and health related quality of life in the elderly. J Korean Gerontol Soc. 2010;30(2):471–484.
27. Kameyama K, Tsutou A, Fujino H. The relationship between health related quality of life and higher-level functional capacity in elderly women with mild cognitive impairment. J Phys Ther Sci. 2016;28(4):1312–1317.Article PubMed PMC
28. Li F, Fisher KJ, Harmer P, McAuley E, Wilson NL. Fear of falling in elderly persons: Association with falls, functional ability, and quality of life. J Gerontol B Psychol Sci Soc Sci. 2003;58(5):P283–P290.Article PubMed
29. McAuley E, Blissmer B. Self-efficacy determinants and consequences of physical activity. Exerc Sport Sci Rev. 2000;28(2):85–88. PubMed
30. Fernandez A, Garcia-Alonso J, Royo-Pastor C, Garrell-Corbera I, Renqel-Chica J, Aqudo-Ugena J, et al. Effects of the economic crisis and social support on health-related quality of life: First wave of a longitudinal study in Spain. Br J Gen Pract. 2015;65(632):e198–e203.Article PubMed PMC

Figure & Data

References

Citations

Citations to this article as recorded by

Multilevel Analysis of Factors Affecting Health-Related Quality of Life of the Elderly
Hyunjung Moon, Sunkyung Cha
Journal of Korean Academy of psychiatric and Mental Health Nursing.2022; 31(3): 391. CrossRef
Frailty and Quality of Life among Older Adults in Communities: The Mediation Effects of Daily Physical Activity and Healthy Life Self-Efficacy
Chia-Hui Lin, Chieh-Yu Liu, Chun-Ching Huang, Jiin-Ru Rong
Geriatrics.2022; 7(6): 125. CrossRef
The Effects of COVID-19 Risk Perception in Women in Their 20s and 30s on Preventive Efficiency and Beauty Health Care Behaviors
Chae-Won Lim, Ju-Youn Kim
Journal of the Korean Society of Cosmetology.2021; 27(6): 1461. CrossRef
Effects of a Person-Centered Nursing Intervention for Frailty among Prefrail Community-Dwelling Older Adults
Jiyeon Ha, Yeon-Hwan Park
International Journal of Environmental Research and Public Health.2020; 17(18): 6660. CrossRef
Understanding and Prevention of Fall-related Injuries in Older Adults in South Korea: A Systematic Review
Ki-taek Lim, Ji-eun Lee, Ha-eun Park, Su-young Park, Woochol Joseph Choi
Physical Therapy Korea.2019; 26(2): 34. CrossRef
Effects of the Elderly's Health Statuses, Health Behavior, and Social Relations on Their Health-related Quality of Life: Focusing on Family Types
Young Bum Kim, Seung-Hee Lee
Journal of Korean Academy of Community Health Nursing.2018; 29(3): 310. CrossRef

PubReader
Cite

CITE

export Copy Format

Close

XML Download

We recommend

Related articles

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.