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. 2025 May;25(3):e70030.
doi: 10.1111/psyg.70030.

A serial mediation model of chronic multimorbidity and frailty in older adults: the role of pain and depressive symptoms

Ting Rong  1   2 , Li Kang  1   2 , Yi Zhang  2   3 , Lanxin Yin  2   3 , Yuexia Gao  1 , Jianlin Gao  2
Affiliations

A serial mediation model of chronic multimorbidity and frailty in older adults: the role of pain and depressive symptoms

Ting Rong et al. Psychogeriatrics. 2025 May.

Abstract

Background: Previous studies have shown that chronic multimorbidity is associated with frailty in older adults. However, the mechanisms of this association are unclear. This study aimed to determine the mediating role of pain and depressive symptoms in the relationship between chronic multimorbidity and frailty.

Methods: We examined the relationship between chronic multimorbidity, pain, depressive symptoms, and frailty in a cross-sectional survey of 501 older adults (48.5% male, median age = 74 years).

Results: There was a positive correlation between chronic multimorbidity and frailty in older adults. In addition, pain and depressive symptoms mediated the relationship between chronic multimorbidity and frailty both independently and serially. The total indirect effect of the three mediation paths was 36%.

Conclusion: Active treatment of the primary conditions of older adults, supplemented by attention given to physical and mental health issues such as pain and depressive symptoms, could prevent the development of frailty in older adults.

Keywords: chronic multimorbidity; depressive symptoms; frailty; older adults; pain.

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