The mediating role of frailty and depression between social support and self-management pathway in elderly COPD patients: a cross-sectional study

Abstract Objectives: Chronic obstructive pulmonary disease (COPD) represents a serious threat to global public health safety, and no effective way to cure COPD has been identified. Its treatment is mainly focused on stabilization of the stage and reduction of symptoms. Self-management (SM) is the primary factor in controlling the progress of the disease. Social support has been proven to have a promoting effect on self-management; however, one independent factor cannot fully account for the complex mechanisms of self-management. The incidence of frailty and depression is relatively high among patients with COPD, which influences their level of SM. Unfortunately, there is still a lack of research on the underlying mechanisms among the four variables mentioned above. The aim of this study is to understand the current status of social support and self-management in elderly patients with COPD, and to explore the double mediating role of depression and frailty between social support and self-management. Study design: This is a cross-sectional study. Methods: This study used a convenience sampling method, and selected 627 elderly COPD patients who was hospitalized in 5 public hospitals in the Ningxia region of northwest China from November 2020 to July 2021 as the survey subjects. The survey content included general information, the COPD Self-management Scale (COPD-SMS), Frail Scale (FS), 15-item Geriatric Depression Scale (15-GDS), and Social Support Rating Scale (SSRS). The correlation between variables used Pearson’s product-moment correlation analysis. SPSS25.0 PROCESS plugin Model 6 was used to test the mediating effect of frailty and depression between social support and self-management. Results: Among the sample, the total participants contained 248 females and 379 males. The mean age was 72.87 years, and the standard deviation was 7.03. The mean COPD-SMS was 156.99, with a standard deviation of 25.15. Analysis of the mediating effect revealed that social support can directly predict SM, and can also predict through the mediation of depression and frailty-depression, but the mediation of frailty alone was not significant. The direct and indirect effect accounted for 84.06% and 15.94% of the total effect respectively. Conclusion: The SM of elderly COPD patients in the Ningxia of northwest China was at a moderate-to-low level, and the frailty and depression played a partial mediating role in social support and self-management pathways. The research provided that the medical profession should pay attention to the patients' frailty and depression status and provide targeted intervention measures during the intervention.