Symptom Clusters and Frailty Among Older Adults With and Without Cancer: Insights From Two Cross-Sectional Studies

This study aims to examine the relationship between symptom clusters (depressive symptoms, sleep disturbances, and pain) and frailty in older adults, with a specific focus on mediation and moderation effects. Data from two cross-sectional studies in Changsha and Hong Kong were analyzed, including nursing home residents without cancer and older adults with cancer. Study-stratified analyses were conducted in SPSS 26.0 and PROCESS, with adjustment for available covariates. Mediation tested whether sleep disturbances were indirectly associated with depressive symptoms and frailty, and moderated mediation examined whether pain severity or interference conditioned the association between depressive symptoms and sleep disturbances. In both groups, frailty, depressive symptoms, sleep disturbances, and pain were significantly associated. Sleep disturbances showed a significant indirect association between depressive symptoms and frailty in both groups. Pain interference, but not pain severity, moderated the association between depressive symptoms and sleep disturbances only among older adults without cancer. The findings highlight the importance of assessing and managing depressive symptoms, sleep disturbances, and pain-related interference when addressing frailty in older adults, particularly among those without cancer.