The bidirectional association between self-perceptions of aging and frailty: the mediating role of subjective cognitive decline

Abstract

Objective With the global population aging rapidly, understanding the factors influencing health outcomes in older adults is crucial. This study explores the longitudinal causal relationship between self-perceptions of aging and frailty and examines whether subjective cognitive decline mediated the associations. Methods The Brief-Aging Perceptions Questionnaire(B-APQ), the Frailty Phenotype Assessment Scale, and the Subjective Cognitive Decline Questionnaire were used to survey 619 community-dwelling older adults in Xinxiang, Henan, China, from March to October 2021 and from March to October 2023, respectively. A cross-lagged model was employed to analyze the potential mediating roles of subjective cognitive decline, controlling for confounders including age, gender, income, employment status, and education. Results (1) The cross-lagged model analysis revealed a bidirectional causal relationship between self-perceptions of aging and frailty ( P < 0.001), with the effect of T1 self-perceptions of aging on T2 frailty ( β = 0.109, SE = 0.038, P < 0.01) and the reverse effect ( β = 0.129, SE = 0.041, P < 0.01). Further comparisons of the path coefficients indicated that the effect sizes of the two paths showed no statistical difference ( χ 2 = 0.119, P > 0.05). (2) The longitudinal mediation analysis indicated that T1 self-perceptions of aging had an indirect effect on T2 frailty through subjective cognitive decline (indirect effect = 0.011). Concurrently, T1 frailty also indirectly influenced T2 self-perceptions of aging via subjective cognitive decline (indirect effect = 0.010), with all effects demonstrating statistical significance ( P < 0.05). Conclusion This study demonstrates a bidirectional causal relationship between self-perceptions of aging and frailty, with subjective cognitive decline identified as a mediating mechanism. These findings provide important guidance for future efforts aimed at reducing frailty rates among older adults in community settings.