Impacts Of Frailty On Spousal Health Status Among Middle-aged And Older Adults

ObjectivesAlong with the rapid rise in the number and proportion of middle-aged and elderly population,the social concern for the health of middle-aged and elderly people is also increasing,and the prevention of elderly diseases and improvement of elderly health functions have become the consensus of social development.As a clinical syndrome that occurs with aging,frailty is associated with a wide range of adverse health events such as hospitalization,falls,and death on its own,and will place a heavy burden on families and the health care system.It is a hot issue in the current international geriatrics research field and a public health priority proposed by the World Health Organization.However,most of the previous studies on frailty have focused on older adults themselves,and fewer studies have analyzed the effects of frailty on spousal health status from a couple’s perspective.Middle-aged and older couples share the same environment,resources,and stressful events,and their emotions also depend on each other,couples’emotions and health are closely linked and are likely to influence each other.And when middle-aged or older adults suffer from frailty or poor health,spouses often need to provide care for them as close companions and dependents,which can also lead to physical or mental health problems that affect the quality of life.Therefore,based on the frailty of the middle-aged and elderly population,this research explored the impact of frailty on spousal health status among middle-aged and older adults,and whether the association between frailty and spousal health status differs by gender or age from the perspective of couple health.On this basis,we further explored the moderating role of spousal social participation in the correlation of health and proposed relevant recommendations for frailty prevention and health promotion in middle-aged and older adults.It is expected to provide a secundum for decision-making to optimize health service utilization,family care policies and achieve healthy aging.Subjects and MethodsThe longitudinal data of 2011-2018 from the China Health and Retirement Longitudinal Study（CHARLS）was selected and the 2011 survey data as the baseline was used in this study.The sample was selected from middle-aged and older couples aged 45 years and older who attended at least one of the follow-up visits in 2013,2015 and 2018.After removing the sample with missing relevant variables,8616 subjects（4308 couples）were finally included.In this study,the Stata 16 software was used to sort and analyze the data,and the statistical calibration level was set to two-sidedα=0.05.First,mean and standard deviation,median and interquartile range,or frequency and composition ratios were used to perform descriptive analyses of the basic characteristics,frailty,and health status of the subjects,and the differences between the different characteristic groups were analyzed using chi-square tests or Kruskal-Wallis tests.Second,the impact of frailty on spousal health status among middle-aged and older adults was analyzed using generalized estimating equation（GEE）models and stratified by gender and age.Finally,the moderating effect model was used to explore whether there is a moderating role of spousal social participation in the relationship between frailty and spousal health status among middle-aged and older adults.Results（1）Among the 4308 middle-aged and older couples included in this study,the mean age of the husbands was 58.67（standard deviation 8.38）years and the mean age of the wives was 56.65（standard deviation 7.86）years.For husbands,the proportions of those who were in pre-frailty and frailty status at baseline were 44.66%and 4.97%,respectively.While the percentage of wives who were in pre-frailty and frailty status at baseline was 52.11%and 6.85%,respectively.The results of the paired chi-square test showed that husbands were relatively older,more educated,more likely to have an urban household,to smoke or drink alcohol,and not have multiple chronic diseases compared to wives at baseline.As time progressed,the median scores for frailty,depression,and cognition differed among middle-aged and older adults,while self-rated health and life satisfaction scores were more stable and did not change significantly.In addition,men had better median scores than women on all health indicators,and middle-aged adults had better median scores than older adults on all five health indicators of self-rated health,functional limitations,frailty,depression,and cognition,except for life satisfaction.（2）Results of a longitudinal data analysis showed that spouses of adults in pre-frailty and frailty status had worse levels of frailty,self-rated health,functional limitation,life satisfaction,depression,and cognition compared to adults who without frailty.And for each unit increase in the frailty index of middle-aged and older adults,their spouses’frailty,self-rated health,functional limitations,life satisfaction,depression,and cognition also became significantly worse（frailty:β=0.13[0.12,0.15],self-rated health:β=-0.10[-0.14,-0.07],functional limitations:β=0.29[0.20,0.38],life satisfaction:β=-0.05[-0.08,-0.03],depression:β=1.04[0.88,1.21],and cognition:β=-0.46[-0.62,-0.31];P<0.001）.The above results were consistent in the crude model without adjusting for any confounding variables and in the model after adjusting for spousal gender,age,household,region,education,income,health insurance,smoking,drinking,social participation,and multimorbidity.（3）Results of the gender-stratified analysis showed that for each unit increase in the husbands’frailty index,his wives’frailty,self-rated health,functional limitations,life satisfaction,depression,and cognition were significantly worse（all P<0.05）.In contrast,for each unit increase in the wives’frailty index,their husbands’frailty,self-rated health,functional limitations,depression,and cognition also became significantly worse（all P<0.05）,but the husbands’life satisfaction status was not significantly affected（β=-0.03[-0.06,0.01],P>0.05）.Gender interaction analysis revealed no significant gender differences in the effects of frailty on spousal frailty,self-rated health,functional limitations,depression,and cognition among middle-aged and older adults(all P_interaction>0.05).However,there were significant gender differences in the effect of frailty on spousal life satisfaction among middle-aged and older adults,with women more likely to be affected than men(all P_interaction=0.04).In addition,the results of the age-stratified analysis showed that for each unit increase in the frailty index in both middle-aged and elderly populations,their spouses’frailty,self-rated health,functional limitations,life satisfaction,depression,and cognition became significantly worse,and no significant age group differences were seen for the above spousal health interactions（all Pinteraction>0.05）.（4）The results of the moderating effect analysis revealed a significant moderating effect of social participation in the relationship between the effects of middle-aged and elderly frailty on spousal frailty,self-rated health,functional limitations and depression among middle-aged and older adults,social participation weakened the negative effects of frailty on spousal frailty(no social participation:β=0.15[0.13,0.18],with social participation:β=0.11[0.09,0.14],P_interaction<0.05),self-rated health(no social participation:β=-0.15[-0.19,-0.10],with social participation:β=-0.06[-0.11,-0.01],P_interaction<0.05),functional limitations(no social participation:β=0.41[0.26,0.56],with social participation:β=0.16[0.06,0.27],P_interaction<0.05),and depression(no social participation:β=1.32[1.08,1.56],with social participation:β=0.81[0.58,1.04],P_interaction<0.05)among middle-aged and older adults.However,the moderating effects of social participation in the relationship between frailty on spousal life satisfaction and cognition was not significant(P_interaction>0.05)among middle-aged and older adults.Conclusions（1）The overall health status of Chinese middle-aged and older adults is poor.Overall,men had better levels than women on the health indicators of frailty index,self-rated health,functional limitations,life satisfaction,depression,and cognition,and the middle-aged population had better health overall than the older population（except for life satisfaction）.（2）Frailty has a significant negative impact on spousal health status among middle-aged and older adults,it means that spouses of adults with higher levels of frailty can have significantly worse health status in terms of frailty,self-rated health,functional limitations,life satisfaction,depression,and cognition compared to adults without frailty.（3）No age group differences or gender differences in the negative impact of frailty on spousal health status among middle-aged and older adults were found overall in this study.With only one exception,there was a gender difference in the negative impact of frailty on spousal life satisfaction among middle-aged and older adults,that is,wives’life satisfaction was more likely to be affected by spousal frailty compared to husbands.（4）Significant moderating effects of social participation in the effects of frailty on spousal frailty,self-rated health,functional limitation and depression,social participation weakened the negative effects of frailty on spousal frailty,self-rated health,functional limitations and depression among middle-aged and older adults,but the moderating effect of social participation in the relationship between frailty on spousal life satisfaction and cognition was not significant.