ORIGINAL RESEARCH article
Front. Psychol.
Sec. Psychology of Aging
Volume 16 - 2025 | doi: 10.3389/fpsyg.2025.1691997
Psychological states mediate the relationship between sleep quality and frailty among older adults
Provisionally accepted
- 1Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
- 2Dongge Community Health Service Center, Nanning, China
- 3Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Objective: Frailty prevalence is high among older adults. While the association between poor sleep quality and frailty is established, the mediating role of psychological states (anxiety/depression) and the moderating influence of multidimensional factors (physiological conditions, dietary habits, lifestyle factors) on this pathway remain unclear. This study aimed to examine the mediating effects of anxiety and depression on the sleep quality-frailty link and identify moderators of the sleep quality-psychological state relationship among community-dwelling older adults. Methods: A cross-sectional survey was conducted among 900 adults aged ≥60 years in Dongge Community, Nanning, Guangxi. Sleep quality, anxiety, depression, and frailty were assessed using the Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS-A/HADS-D), and FRAIL scale, respectively. Data on physiological conditions, dietary habits, and lifestyle factors were collected via questionnaire. Parallel mediation and moderated mediation analyses were performed. Results: Mean scores were: HADS-A=1.00±1.76, HADS-D=1.32±2.11, PSQI=6.41±3.22, FRAIL=0.96±1.05. Parallel mediation analyses confirmed that both anxiety (B=0.029, 95%CI [0.004, 0.060]) and depression (B=0.018, 95%CI [0.001, 0.042]) partially mediated the association between poor sleep quality and frailty, collectively accounting for 23.50% of the total effect. Moderated mediation analyses revealed that bodily pain, specific dietary habits (intake frequency ≥5 times/week of milk, soybeans, and fish/meat/eggs), and daily outdoor exercise duration (≥30 minutes) significantly moderated the strength of the mediating pathway through anxiety (i.e., the "sleep quality → anxiety" link). Conclusions: Anxiety and depression significantly mediate the relationship between poor sleep quality and frailty in older adults. Crucially, this mediating pathway via anxiety is modifiable, being attenuated by the absence of bodily pain, frequent consumption of key protein-rich foods, and regular outdoor exercise. These findings highlight potential targets for multi-faceted interventions aimed at mitigating frailty risk by improving sleep and psychological well-being in aging populations.
Keywords: older adults, Frailty, sleep quality, Psychological state, moderated mediation
Received: 25 Aug 2025; Accepted: 22 Oct 2025.
Copyright: © 2025 Wei, Zhang, Lin, Hu, Lv, Li, He, Su and Ni. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xiaolin Ni, xiaolin_ni7@126.com
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