Zhao Huan, Zhong Yaping
College of Public Health, Medical and Veterinary Science, James Cook University, Townsville, Queensland, Australia.
Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.
J Am Med Dir Assoc. 2025 Aug;26(8):105707. doi: 10.1016/j.jamda.2025.105707. Epub 2025 Jun 14.
Frailty and poor psychological functioning remain major aging-related public and clinical health challenges. The multidimensional nature of these constructs, along with diverse assessment methods, complicate the study of their relationship. This study aims to examine the cross-sectional and longitudinal relationships between frailty and psychological functioning and explore how their interplay affects health-related outcomes in community-dwelling older adults.
Systematic review.
Community-dwelling older adults.
We conducted a systematic search of MEDLINE, Embase, Emcare, PsycINFO, CINAHL, Web of Science, and Scopus for English-language articles published between January 2001 and November 2024. Two authors independently screened studies, extracted data, and performed quality assessment. Data were analyzed descriptively.
A total of 129 studies were included, covering 113 distinct cohorts of community-dwelling older adults from 37 countries. Cross-sectional analyses consistently found positive associations between frailty and depression, psychological distress, and apathy, and negative associations with mental well-being, optimism, and sense of coherence, with mixed findings for anxiety. Longitudinal studies showed that baseline depression, apathy, and poor mental vitality predicted frailty progression, while frailty at baseline predicted incident depression and worsened mental health. The interaction between frailty and depression was associated with poorer health outcomes, including increased mortality, functional disability, and hospitalization risks.
Community-based frailty management strategies should consider a broader range of psychological factors, such as mental vitality, apathy, and mental well-being. Further research is needed to explore additional psychological dimensions beyond depression and anxiety, and their relationship with frailty and aging-related health outcomes.
虚弱和心理功能不佳仍然是与衰老相关的主要公共卫生和临床健康挑战。这些概念的多维度性质，以及多样的评估方法，使得对它们之间关系的研究变得复杂。本研究旨在探讨虚弱与心理功能之间的横断面和纵向关系，并探究它们的相互作用如何影响社区居住老年人的健康相关结局。
系统评价。
社区居住老年人。
我们对MEDLINE、Embase、Emcare、PsycINFO、CINAHL、Web of Science和Scopus进行了系统检索，以查找2001年1月至2024年11月期间发表的英文文章。两位作者独立筛选研究、提取数据并进行质量评估。对数据进行描述性分析。
共纳入129项研究，涵盖来自37个国家的113个不同的社区居住老年人群队列。横断面分析一致发现，虚弱与抑郁、心理困扰和冷漠呈正相关，与心理健康、乐观和连贯感呈负相关，而焦虑的结果不一。纵向研究表明，基线时的抑郁、冷漠和心理活力差可预测虚弱的进展，而基线时的虚弱可预测新发抑郁和心理健康恶化。虚弱与抑郁之间的相互作用与更差的健康结局相关，包括死亡率增加、功能残疾和住院风险。
基于社区的虚弱管理策略应考虑更广泛的心理因素，如心理活力、冷漠和心理健康。需要进一步研究探索除抑郁和焦虑之外的其他心理维度，以及它们与虚弱和衰老相关健康结局的关系。
