Attitudes to aging mediated the reciprocal associations between frailty and depressive symptoms: ageism as a moderator

Abstract Background The bidirectional causality between frailty and depressive symptoms (DS) in older adults was demonstrated, while the mechanism remains unclear. This study aimed to examine the meditating effect of Attitudes to Aging (AA) in these reciprocal relationships and explore a moderator of ageism. Methods Data from the second wave of a community-based cohort study in Shanghai, were analyzed. Participants included 4,522 older adults aged 60 and above, with an average age of 72.3 years (SD = 6.4), and with 55.4% being women. Frailty, DS, AA and ageism were measured using valid scales. Moderated mediation analyses were performed using the PROCESS Marco for SPSS. Results In moderated mediation model, controlling for covariates, both frailty (β = 0.274, P < 0.001) and AA (β = -0.057, P < 0.001) had significant associations with DS. There was a significant interaction effect between ageism and AA (β = -0.085, P = 0.002), but not between ageism and frailty (P = 0.214). Similarly, in the path from DS to frailty, frailty showed significant relationships with DS (β = 0.304, P < 0.001) and AA (β = -0.060, P < 0.001). The interaction effect between DS and ageism (β = -0.066, P = 0.009) was significant, while not significant between AA and ageism (P = 0.851). Conclusions The findings highlight the importance of AA and addressing ageism as preventive measures for frailty and DS, and may offer valuable implications for future research and interventions in older population.