Abstract
Background
Providing the necessary supportive environment is important for promoting healthy ageing and ensuring the well-being of older adults. However, whether social support could buffer the detrimental effect of reversible cognitive frailty (RCF) on health outcomes among older adults has not been empirically examined.
Objective
To examine the moderating effect of three dimensions of social support on the relationship between RCF and health outcomes, including functional ability (FA) and health-related quality of life (HRQoL).
Methods
This was a cross-sectional study with 1171 community-dwelling older adults. Social support was assessed using the Social Support Rating Scale. RCF was identified by the Frailty Phenotype and simplified subjective cognitive decline questionnaire. As for FA, the Katz index and the Lawton Scale were used to measure activities of daily living (ADL) and instrumental ADL (IADL), respectively. HRQoL was measured by the Short Form Health Survey. Hierarchical linear regression analysis was implemented to test the moderating effects.
Results
Support utilization buffered the effect of RCF on IADL ability while subjective support buffered the effect of RCF on physical HRQoL. However, objective support had no significant moderating effect on the relationship between RCF and any health outcomes.
Conclusion
The moderating effect of social support on the relationship between RCF and health outcomes varies by support types and by specific health outcomes. Effective interventions should target the perception and utilization of available support among older adults with RCF to maintain their functional independence and HRQoL.


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References
C., C. and R. E (2019). Loneliness and isolation, barriers and conditionings in the field of older people in Spain. Ehquidad Rev Int Políticas Bienestar Trab Soc: 127–154. https://doi.org/10.15257/ehquidad.2019.0012
Annear., M. J., Keeling., S., Wilkinson., T. J., Cushman., G., Gidlow., B., & Hopkins, H. J. A. (2012). Society, environmental influences on healthy and active ageing: A systematic review. 34: 590–622.
Antonucci, T. C., Akiyama, H., & Takahashi, K. (2004). Attachment and close relationships across the life span. Attachment & Human Development, 6(4), 353–370. https://doi.org/10.1080/1461673042000303136
Antonucci, T. C., Ajrouch, K. J., & Birditt, K. S. (2013). The convoy model: Explaining social relations from a multidisciplinary perspective. The Gerontologist, 54(1), 82–92. https://doi.org/10.1093/geront/gnt118
Bandura, A. (1997). Self-efficacy: The exercise of control. W H Freeman/Times Books/ Henry Holt & Co.
Cohen, S., & Mckay, G. (1984). Social support, stress, and the buffering hypothesis: A theoretical analysis, handbook of psychology and health. Volume IV.
Dedeyne, L., Deschodt, M., Verschueren, S., Tournoy, J., & Gielen, E. (2017). Effects of multi-domain interventions in (pre)frail elderly on frailty, functional, and cognitive status: A systematic review. Clinical Interventions in Aging Volume, 12, 873–896. https://doi.org/10.2147/cia.S130794
Delva, F., Auriacombe, S., Letenneur, L., Foubert-Samier, A., Bredin, A., Clementy, A., Latxague, C., Puymirat, E., Ballan, G., Delabrousse-Mayoux, J. P., Glénisson, L., Mazat, L., Spampinato, U., Rainfray, M., Tison, F., & Dartigues, J. F. (2014). Natural history of functional decline in Alzheimer’s disease: A systematic review. Journal of Alzheimer’S Disease, 40(1), 57–67. https://doi.org/10.3233/jad-131862
Doubova Dubova, S. V., Perez-Cuevas, R., Espinosa-Alarcon, P., & Flores-Hernandez, S. (2010). Social network types and functional dependency in older adults in Mexico. Bmc Public Health, 10, 104. https://doi.org/10.1186/1471-2458-10-104
Drinkwater, C., Wildman, J., & Moffatt, S. (2019). Social Prescribing Bmj 364: l1285. https://doi.org/10.1136/bmj.l1285.
E, K., C. M, C. M and e. al (2013). Cognitive frailty: Rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group. The Journal of Nutrition Health & Aging, 17(9), 726–734. https://doi.org/10.1007/s12603-013-0367-2
Etxeberria, I., Urdaneta, E., & Galdona, N. (2019). Factors associated with health-related quality of life (HRQoL): Differential patterns depending on age. Quality of Life Research, 28(8), 2221–2231. https://doi.org/10.1007/s11136-019-02182-0
Feng, L., Zin Nyunt, M. S., Gao, Q., Feng, L., Yap, K. B., & Ng, T. P. (2017). Cognitive frailty and adverse health outcomes: Findings from the Singapore longitudinal ageing studies (SLAS). Journal of the American Medical Directors Association, 18(3), 252–258. https://doi.org/10.1016/j.jamda.2016.09.015
Gao, J., Hu, H., & Yao, L. (2020). The role of social engagement in the association of self-reported hearing loss and health-related quality of life. BMC Geriatrics, 20(1). https://doi.org/10.1186/s12877-020-01581-0
Gardiner, C., Geldenhuys, G., & Gott, M. (2018). Interventions to reduce social isolation And loneliness among older people: An integrative review. Health and Social Care in the Community, 26(2), 147–157. https://doi.org/10.1111/hsc.12367
Gómez-Morales, A., Miranda, J. M. A., Pergola-Marconato, A. M., Mansano-Schlosser, T. C., Mendes, F. R. P., & Torres, G. V. (2019). The influence of activities on the quality of life of the elderly: A systematic review. Cien Saude Colet, 24(1), 189–202. https://doi.org/10.1590/1413-81232018241.05452017
Gu, Y. H., Bai, J. B., Chen, X. L., Wu, W. W., Liu, X. X., & Tan, X. D. (2019). Healthy aging: A bibliometric analysis of the literature. Experimental Gerontology, 116, 93–105. https://doi.org/10.1016/j.exger.2018.11.014
Hong, J. H., Lachman, M. E., Charles, S. T., Chen, Y., Wilson, C. L., Nakamura, J. S., VanderWeele, T. J., & Kim, E. S. (2021). The positive influence of sense of control on physical, behavioral, and psychosocial health in older adults: An outcome-wide approach. Preventive Medicine, 149. https://doi.org/10.1016/j.ypmed.2021.106612
Hoogendijk, E. O., van Hout, H. P., van der Horst, H. E., Frijters, D. H., Dent, E., Deeg, D. J., & Huisman, M. (2014). Do psychosocial resources modify the effects of frailty on functional decline and mortality? Journal of Psychosomatic Research, 77(6), 547–551. https://doi.org/10.1016/j.jpsychores.2014.09.017
Huang, F., & Fu, P. (2021). Intergenerational support and subjective wellbeing among oldest-old in China: The moderating role of economic status. Bmc Geriatrics, 21(1), 252. https://doi.org/10.1186/s12877-021-02204-y
Huang, L., & Li, J. (2015). Comparison of quality of life and social support of older adults in ChengDu City. Chinese Journal of Gerontology, 35, 6546–6547. https://doi.org/10.1186/1471-2288-12-37
Jalenques, I., Rondepierre, F., Rachez, C., Lauron, S., & Guiguet-Auclair, C. (2020). Health-related quality of life among community-dwelling people aged 80 years and over: A cross-sectional study in France. Health and Quality of Life Outcomes, 18(1), 126. https://doi.org/10.1186/s12955-020-01376-2
Jessen, F., Amariglio, R. E., van Boxtel, M., Breteler, M., Ceccaldi, M., Chételat, G., Dubois, B., Dufouil, C., Ellis, K. A., van der Flier, W. M., Glodzik, L., van Harten, A. C., de Leon, M. J., McHugh, P., Mielke, M. M., Molinuevo, J. L., Mosconi, L., Osorio, R. S., Perrotin, A., Petersen, R. C., Rabin, L. A., Rami, L., Reisberg, B., Rentz, D. M., Sachdev, P. S., de la Sayette, V., Saykin, A. J., Scheltens, P., Shulman, M. B., Slavin, M. J., Sperling, R. A., Stewart, R., Uspenskaya, O., Vellas, B., Visser, P. J., & Wagner, M. (2014). A conceptual framework for research on subjective cognitive decline in preclinical Alzheimer’s disease. Alzheimer’s & Dementia, 10(6), 844–852. https://doi.org/10.1016/j.jalz.2014.01.001
Kapan, A., Winzer, E., Haider, S., Titze, S., Schindler, K., Lackinger, C., & Dorner, T. E. (2017). Impact of A lay-led home-based intervention programme on quality of life in community-dwelling pre-frail and frail older adults: A randomized controlled trial. BMC Geriatrics, 17(1). https://doi.org/10.1186/s12877-017-0548-7
Kong, L. N., Zhang, N., Yuan, C., Yu, Z. Y., Yuan, W., & Zhang, G. L. (2021). Relationship of social support and health-related quality of life among migrant older adults: The mediating role of psychological resilience. Geriatric Nursing, 42(1), 1–7. https://doi.org/10.1016/j.gerinurse.2020.10.019
Krawczyk-Suszek, M., & Kleinrok, A. (2022). Health-Related quality of life (HRQoL) of people over 65 years of age. International Journal of Environmental Research and Public Health, 19(2). https://doi.org/10.3390/ijerph19020625
Lim, M. Y., Hong, S., Kim, J. H., & Nam, Y. D. (2021). Association between gut Microbiome and frailty in the older adult population in Korea. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 76(8), 1362–1368. https://doi.org/10.1093/gerona/glaa319
López-Ortega, M., & Konigsberg, M. (2020). Health-related quality of life among Jewish older persons in Mexico and its determinants. Health and Quality of Life Outcomes, 18(1). https://doi.org/10.1186/s12955-020-01401-4
Lu, S., Liu, Y., Guo, Y., Ho, H. C., Song, Y., Cheng, W., Chui, C. H. K., Chan, O. F., Webster, C., Chiu, R. L. H., & Lum, T. Y. S. (2021). Neighbourhood physical environment, intrinsic capacity, and 4-year late-life functional ability trajectories of low-income Chinese older population: A longitudinal study with the parallel process of latent growth curve modelling. EClinicalMedicine, 36, 100927. https://doi.org/10.1016/j.eclinm.2021.100927
Ma, W., & Shen, Z. (2023). Impact of community care services on the health of older adults: Evidence from China. Front Public Health, 11, 1160151. https://doi.org/10.3389/fpubh.2023.1160151
McLaughlin, D., Leung, J., Pachana, N., Flicker, L., Hankey, G., & Dobson, A. (2012). Social support and subsequent disability: It is not the size of your network that counts. Age and Ageing, 41(5), 674–677. https://doi.org/10.1093/ageing/afs036
Mekli, K., Nazroo, J. Y., Marshall, A. D., Kumari, M., & Pendleton, N. (2016). Proinflammatory genotype is associated with the frailty phenotype in the english longitudinal study of ageing. Aging Clinical and Experimental Research, 28(3), 413–421. https://doi.org/10.1007/s40520-015-0419-z
Moreno-Tamayo, K., Manrique-Espinoza, B., Ramírez-García, E., & Sánchez-García, S. (2019). Social isolation undermines quality of life in older adults. International Psychogeriatrics, 32(11), 1283–1292. https://doi.org/10.1017/s1041610219000310
Nguyen, V. C., & Hong, G. S. (2023). Change in functional disability and its trends among older adults in Korea over 2008–2020: A 4-year follow-up cohort study. Bmc Geriatrics, 23(1), 219. https://doi.org/10.1186/s12877-023-03867-5
Pan, C., Kelifa, M. O., Liang, J., & Wang, P. (2021). Joint trajectories of disability and related factors among older adults in China. Public Health, 199, 96–102. https://doi.org/10.1016/j.puhe.2021.08.018
Patrick, J. H., Cottrell, L. E., & Barnes, K. A. (2001). Gender, emotional support, and well-being among the rural elderly. Sex Roles, 45, 15–30. https://doi.org/10.1023/A:1013056116857
Reppermund, S., Sachdev, P. S., Crawford, J., Kochan, N. A., Slavin, M. J., Kang, K., Trollor, J. N., Draper, B., & Brodaty, H. (2011). The relationship of neuropsychological function to instrumental activities of daily living in mild cognitive impairment. International Journal of Geriatric Psychiatry, 26(8), 843–852. https://doi.org/10.1002/gps.2612
Rodgers, V., Neville, S., & La Grow, S. (2017). Health, functional ability and life satisfaction among older people 65 years and over: A cross-sectional study. Contemporary Nurse, 53(3), 284–292. https://doi.org/10.1080/10376178.2017.1319286
Ruan, Q., Yu, Z., Chen, M., Bao, Z., Li, J., & He, W. (2015). Cognitive frailty, a novel target for the prevention of elderly dependency. Ageing Research Reviews, 20, 1–10. https://doi.org/10.1016/j.arr.2014.12.004
Seeman, T. E., Bruce, M. L., & McAvay, G. J. (1996). Social network characteristics and onset of ADL disability: MacArthur studies of successful aging. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 51(4), S191–200. https://doi.org/10.1093/geronb/51b.4.s191
Shimada, H., Doi, T., Lee, S., Makizako, H., Chen, L. K., & Arai, H. (2018). Cognitive frailty predicts incident dementia among Community-Dwelling older people. Journal of Clinical Medicine, 7(9). https://doi.org/10.3390/jcm7090250
Shou, J., Ren, L., Wang, H., Yan, F., Cao, X., Wang, H., Wang, Z., Zhu, S., & Liu, Y. (2015). Reliability and validity of 12-item Short-Form health survey (SF-12) for the health status of Chinese community elderly population in Xujiahui district of Shanghai. Aging Clinical and Experimental Research, 28(2), 339–346. https://doi.org/10.1007/s40520-015-0401-9
Sone, T., Nakaya, N., Sugawara, Y., Matsuyama, S., & Tsuji, I. (2023). Effect of social participation on the association between frailty and disability. Archives of Gerontology and Geriatrics, 110, 104989. https://doi.org/10.1016/j.archger.2023.104989
Sowle, A. J., Francis, S. L., Margrett, J. A., Shelley, M. C., & Franke, W. D. (2017). A Community-Based exergaming physical activity program improves Readiness-to-Change and Self-Efficacy among Rural-Residing older adults. Journal of Aging and Physical Activity, 25(3), 432–437. https://doi.org/10.1123/japa.2015-0278
Suprawesta, L., Chen, S. J., Liang, H. Y., Hwang, H. F., Yu, W. Y., & Lin, M. R. (2024). Factors affecting cognitive frailty improvement and progression in Taiwanese older adults. BMC Geriatrics, 24(1). https://doi.org/10.1186/s12877-024-04700-3
Tajvar, M., Fletcher, A., Grundy, E., Karami, B., & Mohabbati, F. (2022). Gender interaction in association of perceived social support and Health-Related quality of life among Iranian older people: A Cross-sectional survey. Health Promotion Perspectives, 12(1), 56–66. https://doi.org/10.34172/hpp.2022.08
Walker, A., & Maltby, T. (2012). Active ageing: A strategic policy solution to demographic ageing in the European union. International Journal of Social Welfare, 21(s1). https://doi.org/10.1111/j.1468-2397.2012.00871.x
Wang, W., Si, H., Yu, R., Qiao, X., Jin, Y., Ji, L., Liu, Q., Bian, Y., Yu, J., & Wang, C. (2022). Effects of reversible cognitive frailty on disability, quality of life, depression, and hospitalization: A prospective cohort study. Aging & Mental Health, 26(10), 2031–2038. https://doi.org/10.1080/13607863.2021.2011835
Wettstein, M., Wahl, H. W., & Heyl, V. (2018). Four-year reciprocal relationships between personality and functional ability in older adults with and without sensory impairment: Focus on neuroticism and agreeableness. Aging & Mental Health, 22(6), 834–843. https://doi.org/10.1080/13607863.2017.1318259
Wilson, R. S., Evans, D. A., Bienias, J. L., Mendes de Leon, C. F., Schneider, J. A., & Bennett, D. A. (2003). Proneness to psychological distress is associated with risk of Alzheimer’s disease. Neurology, 61(11), 1479–1485. https://doi.org/10.1212/01.wnl.0000096167.56734.59
Woods, A., Solomonov, N., Liles, B., Guillod, A., Kales, H. C., & Sirey, J. A. (2021). Perceived social support and interpersonal functioning as predictors of treatment response among depressed older adults. The American Journal of Geriatric Psychiatry: official Journal of the American Association for Geriatric Psychiatry, 29(8), 843–852. https://doi.org/10.1016/j.jagp.2020.12.021
World Health Organization (2015). World Report on Ageing and Health.
Xiao, S. (1994a). Theoretical basis and research applications of social support rating scale. Journal of Clinical Psychiatry, 4, 98–100.
Xiao, S. Y. (1994b). The theoretical basis and research application of social support rating scale. Journal of Clinical Psychiatry, 4, 98–100.
Xiao, Q., Wu, M., & Zeng, T. (2019). Social support networks in Chinese older adults: Health outcomes and Health related behaviors: A path analysis. Aging & Mental Health, 23(10), 1382–1390. https://doi.org/10.1080/13607863.2018.1488941
Yu, J., Jin, Y., Si, H., Bian, Y., Liu, Q., Li, Y., & Wang, C. (2023). Relationship between intrinsic capacity and health-related quality of life among community-dwelling older adults: The moderating role of social support. Quality of Life Research, 33(1), 267–280. https://doi.org/10.1007/s11136-023-03520-z
Zhang, W., & Du, P. (2015). The intergenerational support and psychological Well-Being of the elderly in Mainland of China. Successful Aging. https://doi.org/10.1007/978-94-017-9331-5_10
Zhong, W. F., Wang, X. M., Song, W. Q., Li, C., Chen, H., Chen, Z. T., Lyu, Y. B., Li, Z. H., Shi, X. M., & Mao, C. (2024). Association of lifestyle and Apolipoprotein E gene with risk for cognitive frailty in elderly population in China. Zhonghua Liu Xing Bing Xue Za Zhi, 45(1), 41–47. https://doi.org/10.3760/cma.j.cn112338-20231027-00254
Zunzunegui, M. V. (2003). and e. al. Social networks, social integration, and social engagement determine cognitive decline in community-dwelling Spanish older adults. J Gerontol B Psychol Sci Soc Sci 58(2): s93-s100. https://doi.org/10.1093/geronb/58.2.s93
Acknowledgements
We are most grateful to all the people that agreed to participate in this study for their support, time and patience. We also thank all the staff in the community centers for their patience and cooperation.
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This work was supported by the National Natural Science Foundation of China (NSFC: 72274009), the Humanities and Social Science Fund of Ministry of Education of China (21YJA190009) and the Major Project of the National Social Science Fund of China (No. 21&ZD187). These funding organizations had no role in the design, execution, analysis and interpretation of data, or writing of the study.
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CHJ: Conceptualization; Data curation; Visualization; Writing– original draft, Writing– review & editing; YJQ: Conceptualization; Formal analysis; Validation; Writing– original draft, Writing– review & editing; WWY: Investigation; Methodology; Validation; Writing– review & editing; LQQ: Investigation; Software; Writing– review & editing; LYY: Software; Writing– review & editing; ZWD: Validation; Writing– review & editing; WCL: Funding acquisition; Resources; Project administration; Supervision; Writing– review & editing.
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Chen, H., Yu, J., Wang, W. et al. Reversible Cognitive Frailty, Functional Ability and Health-related Quality of Life among Community-Dwelling Older Adults: the Moderating Role of Social Support. Applied Research Quality Life (2025). https://doi.org/10.1007/s11482-025-10433-1
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DOI: https://doi.org/10.1007/s11482-025-10433-1