Multiple chain-mediating effects of physical frailty and loneliness on family health and social frailty in hospitalized old patients with heart failure: a cross-section study

Background The elderly population in China is about to exceed 300 million, and heart failure (HF) is a significant public health problem that seriously endangers the physical and mental health of the elderly. Hospitalized HF patients often suffer from social and physical frailty, and the family is the principal place of care for the elderly, in addition to the hospital and community. Loneliness is a psychological problem that coexists in both developed and developing countries. There is a lack of research on the relationship between family health, physical frailty, loneliness and social frailty in elderly HF inpatients. Objective This study explores the level of social frailty and the factors that influence elderly HF inpatients. It also examines the correlation between family health, physical frailty, loneliness, and social frailty and verifies the chain mediating role of physical frailty and loneliness in the relationship. Method This cross-sectional study collected four hundred sixty-three questionnaires from Northeast China, Northwest China and South China. The research assessment tools include the FRAIL scale (physical frailty), Family APGAR index (family health), LSNS-6 (loneliness), and HALFT scale (social frailty). Data analysis was performed using multiple regression analysis and the SPSS PROCESS Macro plug-in Model 6. Results Age (B = 0.423, p < .001), number of hospitalizations (B = 0.256, p < .001), and education level (B = 0.116, p = 0.004) were risk factors for social frailty in elderly HF inpatients. Social frailty was found to be at a medium-high level, negatively correlated with family health (r=-.540, p < 0.01) and loneliness scores (r=-.732, p < 0.01), and positively correlated with physical exhaustion (r = .549, p < 0.01). Loneliness and physical frailty played a chain-mediating role between family health and social frailty, with an indirect effect of 18.62%, 59.47%, and 13.4%, respectively, all partial mediation. Conclusion The level of social frailty in elderly HF patients is moderately high, negatively affected by age, the number of hospitalizations and education level; interacts with family health, physical frailty and loneliness; and physical frailty and loneliness chain-mediate family health and social frailty. It is recommended that healthcare professionals should care about the physical, mental and social health of elderly HF inpatients.