The complex interactions of physical, psychological and social frailty in elderly patients with comorbidities: a network analysis

Background: With the aging of the global population, the prevalence of multimorbidity among older adults has emerged as a significant global public health challenge. Furthermore, age-related multidimensional frailty exacerbates underlying conditions in patients with such comorbidities, heightening the risk of adverse outcomes and posing substantial challenges for the management of elderly patients with multimorbidity. Therefore, this study aims to investigate the multidimensional frailty symptom network in elderly patients with multimorbidity, analyze the core symptoms and bridge symptoms among physical-psychological-social frailty symptom clusters, and provide evidence for the development of frailty symptom management strategies to delay frailty progression in this population. Method: A cross-sectional survey was conducted from January to June 2024 using convenience sampling to recruit elderly patients aged ≥65 years with multimorbidity from four community health service centers in Beijing's urban districts. The Tilburg Frailty Index (TFI) was used to assess multidimensional frailty symptoms, including physical, psychological, and social frailty. Symptom networks and bridging network structures were constructed using the qgraph and IsingFit packages in R software. Centrality measures were identified using strength indices, and bridging nodes were identified using bridge strength indices. Results: This study ultimately included 919 valid questionnaires, comprising 590 females (64.2%) and 329 males (35.8%). The mean age of the participants was 74.09 ± 6.03 years. Centrality analysis revealed that difficulty in walking, physical tiredness, and self-assessed physical health were the three symptoms with the highest strength indices among all frailty symptoms. Unexplained weight loss and social support were identified as potentially critical symptoms, exhibiting the lowest node strengths. Additionally, coping ability, social support, and physical tiredness served as bridge symptoms facilitating the co-occurrence of physical, psychological, and social frailty. Among these bridge symptoms, physical tiredness and cognition exhibited the strongest node association between physical and psychological frailty. The node pair that exhibited the strongest association between physical and social frailty was social relations and difficulty in walking. Similarly, coping ability and social support demonstrated strong associations between psychological and social frailty nodes. Conclusion: This study used symptom network analysis to identify the structure of the multidimensional frailty symptom network in community-dwelling elderly patients with multimorbidity. It determined that difficulty in walking, physical tiredness, and self-assessed physical health were core symptoms, and coping ability, social support, and physical tiredness were bridge symptoms. This provides a precise personalized intervention targets for symptom management and delaying frailty progression in patients with multimorbidity. Clinical trial number Not applicable.