Unraveling the Mediating Role of Frailty and Depression in the Relationship between Social Support and Self-management among Chinese Elderly COPD Patients: A Cross-sectional Study
Authors: Zhao Jie , Zhang Xiaona , Li Xindan , Zhang Rui , Chang Yan , Li Yongju , Lu Hongyan 
Published: September 2023

Abstract
Background: Chronic obstructive pulmonary disease (COPD) represents a serious threat to global public health safety, and no effective way to cure COPD has been identified. Self-management is the key factor in controlling the progression of the disease. Social support has been proven to have a positive 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 in elderly COPD patients, which affects their self-management level. Unfortunately, there is still a lack of research on the underlying mechanisms among the four variables mentioned above. Therefore, the purpose of this study was to understand the current status of self-management, and to explore the mediating role of depression and frailty between social support and self- management in this population..
Methods:This study employed a cross-sectional design and convenience sampling to survey elderly COPD patients who were admitted to five public hospitals in the Ningxia region of northwest China from November 2020 to July 2021. The survey aimed to gather information on general characteristics, such as demographic data, as well as specific measurements including the COPD Self-management Scale, Frail Scale, 15-item Geriatric Depression Scale, and Social Support Rating Scale. To examine the relationships between these variables, Pearson’s product- moment correlation analysis was employed. Additionally, SPSS25.0 PROCESS plugin Model 6 was used to explore the mediating effects of frailty and depression on the relationship between social support and self-management.
Results: In the sample, there were a total of 248 females and 379 males. The mean age of participants was 72.87±7.03 years. The mean total score of the COPD Self-management Scale was 156.99±25.15. Scores for the Social Support Rating Scale, Frail Scale, and 15-item Geriatric Depression Scale were significantly positively correlated with COPD Self-management Scale (all p < .01). The analysis of the mediating effect demonstrated that social support has a direct predictive effect on self-management. Additionally, social support can also predict self- management indirectly through the mediation of depression and frailty-depression. However, the mediation effect of frailty alone was not found to be statistically significant. The direct effect accounted for 84.06% of the total effect, while the indirect effect accounted for 15.94% of the total effect.
Conclusion: This study showed that that self-management among elderly COPD patients in Ningxia, northwest China, is relatively moderate to low. Furthermore, frailty and depression were found to have a partially mediating role in the relationship between social support and self-management. Therefore, healthcare professionals take into consideration the frailty and depression status of patients and implement targeted intervention measures as part of their care could enhance self-management behaviors for elderly patients with COPD.