Characteristics of the participants
A total of 380 questionnaires were distributed, and the final sample included 335 elderly people ( a response rate of 88%). The participants’ mean age was 70.8 years old (SD = 6.6). The sample included 188 females (56.1%) and 147 males (43.9%). 84.8% (n = 284) of them were married. Participants living in city or town accounted for 56.1% (n = 188). In terms of the participants’ education level, 54% (n = 181) had primary education. Most of the participants had two or more children (86.9%). The characteristics of study participants are summarized in Table 2.
Table 2
Descriptive statistics of the sample’s characteristics (N = 335)
Characteristics | N | % |
Gender | | |
Male | 147 | 43.9 |
Female | 188 | 56.1 |
Education level | | |
Illiteracy | 66 | 19.7 |
Primary education | 181 | 54 |
Secondary education | 51 | 15.2 |
Higher or above | 37 | 11 |
Marital status | | |
Married | 284 | 84.8 |
Divorced | 11 | 3.3 |
Widowed | 34 | 10.1 |
Unmarried | 6 | 1.8 |
Occupation | | |
Farming occupations | 170 | 50.7 |
social services occupations | 51 | 15.2 |
management occupation | 12 | 3.6 |
business occupations | 4 | 1.2 |
Others | 98 | 29.3 |
Number of children | | |
0 | 7 | 2.1 |
1–2 | 37 | 11 |
≥ 2 | 291 | 86.9 |
Disposable income (yuan/month) | | |
<1000 | 86 | 25.7 |
1001–3000 | 225 | 67.2 |
3001–6000 | 21 | 6.3 |
≥ 6000 | 3 | 0.9 |
Type of medical expenses payment | | |
Basic medical insurance for urban employees | 46 | 13.7 |
Basic medical insurance for urban residents | 164 | 49 |
New rural cooperative medical care | 89 | 26.6 |
Poverty relief | 9 | 2.7 |
Insurance | 6 | 1.8 |
Public expense | 8 | 2.4 |
Full-pay | 6 | 1.8 |
Others | 7 | 2.1 |
Residence | | |
City or town center | 188 | 56.1 |
Urban and rural | 101 | 30.1 |
Countryside | 35 | 10.4 |
Others | 11 | 3.3 |
Caregiver | | |
None | 4 | 1.2 |
Spouse | 82 | 24.5 |
Family member | 235 | 70.1 |
Domestic worker | 14 | 4.2 |
Assistive devices use | | |
None | 262 | 78.2 |
Yes | 73 | 21.8 |
| Mean | Standar deviation (SD) |
Age | 70.8 | 6.6 |
ADL disability | 50.4 | 24.5 |
Frailty | 2.71 | 1.3 |
According to the FRAIL criteria, the mean scores of frailty was 2.71 (SD = 1.3). The prevalence of frailty was 95.2% (n = 319), among which the rates of prefrail, frail and robust were 42.7% (n = 143), 52.5% (n = 176) and 4.8% (n = 16), respectively. Ambulation (67.2%), fatigue (67.1%) and resistance (62.1%) are the most significant frailty phenotypes (Table 3). AS for ADL disability, the mean scores of disability was 50.39 (SD = 24.5). Among participants, 4.8% were ADL independence (n = 16), 20.6% (n = 69) were mild dependence, 30.1% (n = 101) were moderate dependency, 44.5% (n = 149) were severe dependence. Transferring (46%), feeding (46%), and dressing (43%) were the most dependent daily activities (Table 4).
Table 3
Frailty status of the sample
Characterisitics | N(%) |
Robust | 16 (4.8) |
Pre-frailty | 143 (42.7) |
Frailty | 176 (52.5) |
Frailty phenotype | |
Fatigue | 225 (67.1) |
Resistance | 208 (62.1) |
Ambulation | 225 (67.2) |
Illness | 103 (30.7) |
Loss of weight | 146 (43.6) |
Total | 319 (95.2) |
Table 4
ADL disability characteristics of the sample
Characteristics | N(%) |
Feeding | |
Total assistance or artifical feeding | 27 (8.1) |
Need assistance | 127 (37.9) |
Autonomous | 181 (54) |
Dressing | |
Total assistance | 28 (8.4) |
Need assistance | 116 (34.6) |
Autonomous | 191 (57) |
Bathing | |
Need assistance | 82 (24.5) |
Autonomous | 253 (75.5) |
Toileting | |
Total assistance | 40 (11.9) |
Need assistance | 90 (26.9) |
Autonomous | 205 (61.2) |
Bowel continence | |
Incontinence | 9 (2.7) |
Occasional (<1time/week) | 34 (10.1) |
Contrable | 292 (87.2) |
Bladder continence | |
Incontinence | 8 (2.4) |
Occasional (<1time/24h) | 51 (15.2) |
Contrable | 276 (82.4) |
Hygiene | |
Need assistance | 85 (25.4) |
Autonomous | 250 (74.6) |
Walking | |
Cannot walk | 20 (6.0) |
Need devices support | 19 (5.7) |
Need assistance | 81 (24.2) |
Autonomous | 215 (64.2) |
Climbing stairs | |
Cannot climb | 22 (6.6) |
Need assistance | 113 (33.7) |
Autonomous | 200 (59.7) |
Transfering | |
Total assistance | 21 (6.3) |
Need assistance | 25 (7.5) |
Need little assistance | 108 (32.2) |
Autonomous | 181 (54.0) |
ADL disability | 319 (95%) |
Independency | 16(4.8) |
Mild dependency | 69 (20.6) |
Moderate dependency | 101 (30.1) |
Severe dependency | 149 (44.5) |
Influencing Factors Of Frailty
As shown in Table 3, a logistic regression revealed that gender (95% CI: 0.01,0.26; p = 0.04), education level (95% CI: 0.01,0.17; p = 0.028), occupation (95% CI: -0.02, 0.00; p = 0.031), degree of ADL dependence (95% CI: 0.06,0.34; p < 0.01), ADs use (95% CI:-0.23, -0.08; p < 0.01), and ADL scores (95% CI: 0.00, 0.01; p < 0.01), were significantly correlated with frail status (Table 5).
Table 5
Results of the multinomial logistic regression analyses on frailty
Variables | Std.Error | β | P | 95%CI |
Low | high |
Gender | 0.07 | 0.11 | 0.04 | 0.01 | 0.26 |
Education level | 0.04 | 0.13 | 0.03 | 0.01 | 0.17 |
Age | 0.01 | -0.13 | 0.03 | -0.02 | 0.00 |
Occupation | 0.02 | -0.04 | 0.50 | -0.05 | 0.03 |
Marital status | 0.05 | 0.03 | 0.60 | -0.07 | 0.12 |
Number of children | 0.09 | 0.01 | 0.88 | -0.16 | 0.19 |
Disposable income | 0.06 | -0.04 | 0.52 | -0.16 | 0.08 |
Type of medical expenses payment | 0.03 | -0.09 | 0.24 | -0.10 | 0.02 |
Residence | 0.06 | 0.14 | 0.06 | 0.00 | 0.21 |
Caregiver | 0.06 | 0.01 | 0.85 | -0.11 | 0.13 |
Degree of ADL disability | 0.07 | 0.31 | 0.01 | 0.06 | 0.34 |
ADs use | 0.04 | -0.26 | 0.00 | -0.23 | -0.08 |
ADL scores | 0.003 | 0.31 | 0.01 | 0.00 | 0.01 |
Correlations Between Ads Usage, Frailty And Disability
Of 143 pre-frail older adults, 30.1% (n = 43) were ADL mild dependency, 25.9% (n = 37) were moderate dependency, 42% (n = 60) were severe dependency. In Frail group (n = 176), 11.9% (n = 21), 32.4% (n = 57) and 48.2% (n = 85) were mild, moderate and severe ADL dependency (χ2 = 23.23 ; p < 0.01). (Table 6)
Table 6
Information of frailty and disability status
Status | N(%) |
Mild | Moderate | Severe |
Robust | 5(31.3) | 7(43.8) | 4(25) |
Pre-frailty | 43(30.1) | 37(25.9) | 60(42) |
Frailty | 21(11.9) | 57(32.4) | 85(48.3) |
Merely 21.8% of the participants were using ADs. Specifically, 22% (n = 73) of the participants who are ADL dependent were using assistive products, with 36% (n = 25) of the mild one, 30% (n = 30) of the moderate and 8% (n = 12) of the severe dependency. Similarly, 22% of the frail participants were using ADs (n = 73), manifesting as 19% of the pre-frail (n = 27), 19% (n = 34) of the frail participants. (Table 7).
Table 7
ADs use among participants in frailty and ADL disability
Status | ADs usage |
None | Yes |
N(%) |
Robust | 4(25) | 12(75.1) |
Pre-frail | 116(81.1) | 27(19.2) |
Frail | 142(80.7) | 34(19.0) |
Total | 262(78.2) | 73(22.4) |
ADL independency | 10(62.5) | 6(38.3) |
Mild dependency | 44(63.8) | 25(36.0) |
Moderate depedency | 71(70.3) | 30(30.3) |
Severe dependency | 137(91.9) | 12(8.5) |
Total | 262(78.2) | 73(22.1) |
The Pearson’s r correlations between assistive devices use, frailty and disability are presented in Table 8. The statistical results show that frailty is positively associated with disability (r = 0.128, p < 0.001). Assistive devices is negatively correlated with frailty (r = -0.21, p < 0.001) and negatively correlated with disability (r = -0.245, p < 0.001).
Table 8
Correlations (r) between frailty, ADL disability, and ADs use
| Fatigue | Resistance | Ambulation | Ilness | Loss of weight | Frailty | ADs use |
ADs use | -0.03 | .242** | .207** | -0.02 | 0.08 | − .210** | 1.00 |
Feeding | .280** | − .494** | − .423** | 0.10 | .349** | 0.05 | − .152** |
Dressing | .279** | − .474** | − .409** | 0.10 | .355** | 0.03 | − .169** |
Washing | .290** | − .500** | − .474** | 0.04 | .368** | 0.07 | 0.03 |
Toileting | .281** | − .515** | − .393** | 0.07 | .326** | 0.06 | − .156** |
Bowel continence | 0.03 | − .262** | − .176** | .151** | .145** | 0.04 | − .285** |
Bladder continence | 0.07 | − .251** | − .167** | 0.11 | 0.10 | 0.04 | − .378** |
Hygiene | .163** | − .421** | − .440** | 0.04 | .359** | 0.08 | -0.08 |
Walking | .169** | − .407** | − .361** | .190** | .284** | 0.02 | − .243** |
Climbing stairs | .238** | − .534** | − .448** | 0.10 | .347** | 0.08 | − .180** |
Transfering | .179** | − .470** | − .444** | 0.10 | .304** | 0.09 | − .293** |
ADL disability | − .253** | .549** | .474** | − .132* | − .372** | 0.13 | .245** |
Note: *p < 0.05; **p < 0.01 |
Mediation Model Test
The SEM with observed variables was used to test the association between assistive devices use, frailty and disability. The paths from frailty to assistive devices use(β = -0.14, p < 0.01) and to disability (β = 0.39, p < 0.01) were significant. The path from assistive devices using to disability was also significant (β = 0.39, p < 0.01) (Figure 2). The bootstrap (5000 samples) standard error of 0.01 and bootstrap bias corrected 95% CI (0.11, 0.21) did not include zero. Thus, we concluded that there was a mediation effect of ADs using on the relationship between frailty and disability.