Frailty and Self-Care Maintenance Mediated by Social Support and Depression in Older Adults With Heart Failure

Abstract Background Older adults with heart failure often exhibit poor self-care maintenance. Frailty could exacerbate self-care, leading to deteriorating health. Social support and depression may play a role in self-care maintenance in older adults with heart failure combined with frailty. Confirming this potential mechanistic relationship could provide valuable reference for nurses to formulate and improve the targeted intervention strategies and health education programs for older adults with heart failure. Objectives This study analyze the relationship between frailty and self-care maintenance in older adults with heart failure and determined the sequential mediation effect of social support and depression. Its goal was to provide valuable theoretical insights for formulating targeted clinical nursing interventions for older adults with heart failure. Methods A cross-sectional study was conducted from July 2023 to February 2024, during which older adults with heart failure were recruited using a convenience sampling method from the cardiovascular department of a tertiary class A hospital in Qingdao, China. A total of 241 completed the Tilburg Frailty Indicator, the Self-Care of Heart Failure Index, the Social Support Rating Scale, and the Patient Health Questionnaire–9. T-tests and one-way analysis of variance were used to examine differences in self-care maintenance among participants with distinct characteristics; correlation analysis was used to ​identify variable relationships within the study. The mediation model was tested using the SPSS PROCESS macro and the bootstrap method. Results Frailty was negatively correlated with self-care maintenance, and both social support and depression were significantly related to frailty and self-care maintenance. Social support and depression not only independently mediated the relationship between frailty and self-care maintenance but also exhibited a significant sequential mediation effect. Discussion The frailty of older adults with heart failure and its correlation with self-care maintenance is a complex and multidimensional phenomenon. Frailty not only directly influenced self-care maintenance in participants but also indirectly affected it through the mediating factors of social support and depression. Future research should emphasize innovative, targeted interventions to enhance social support quality and accessibility and alleviate depression, ultimately boosting patients’ self-care capabilities and elevating their quality of life.