来自国家健康和老龄化趋势研究（N = 7,609）的社区居民老年人，该研究是美国医疗保险受益人的全国代表性调查。
衰弱状态通过身体衰弱表型5个特征确定，包括 :(1) 动作减慢 ;(2 )体重减轻 ;(3) 力量 ( 抓力 )减弱 ;(4) 疲劳 ;(5) 身体 活动减少 / 低能量消耗。疼痛根据上个月自我报告的疼痛来确定。失眠包括自我报告睡眠困难和难以维持睡眠。抑郁症状由患者健康问卷2评估。使用Logistic回归模型对社会人口统计学，健康相关和行为协变量进行调整。
Frailty is prevalent in older adults and has adverse effects on multiple health outcomes. Pain, insomnia, and depressive symptoms are commonly seen and treatable symptoms in older adults and are associated with frailty. However, it is unknown whether these symptoms are independently associated with frailty and how they interact with each other creating a greater impact on frailty than individual symptoms. It is important to understand these associations for nurses to provide high-quality patient-centered care for older adults with frailty.
To determine independent associations of pain, insomnia, and depressive symptoms with frailty and examine their synergistic impact on frailty among older adults.
A cross-sectional analysis of a cohort study.
Communities in the United States.
Community-dwelling older adults from the National Health and Aging Trend Study (N=7,609), a nationally representative survey of Medicare Beneficiaries in the United States.
Frailty status was determined by five criteria of the Physical Frailty Phenotype: exhaustion, low physical activity, weakness, slowness, and shrinking. Pain was determined by self-reports of bothersome pain in the last month. Insomnia included self-reports of difficulty initiating sleep and difficulty maintaining sleep. Depressive symptom was assessed by the Patient Health Questionnaire-2. Logistic regression models were used adjusting for sociodemographic, health-related and behavioral covariates.
The sample was mainly under 80 years old (72%), female (57%), and non-Hispanic White (81%). Approximately 53% experienced bothersome pain, 11% had difficulty initiating sleep, 6% had difficulty maintaining sleep, and 15% had depressive symptom; 46% were pre-frail and 14% were frail. Independent associations with pre-frailty and frailty were found in pain (odds ratio [OR]: 1.81, 95% CI: 1.60, 2.04), difficulty initiating sleep (OR: 1.23, 95% CI: 1.04, 1.46) and depressive symptom (OR: 2.29, 95% CI: 1.85, 2.84). Interaction terms between pain and depressive symptom (OR: 1.87, 95% CI: 1.14, 3.07), and between difficulty initiating sleep and depressive symptom (OR: 2.66, 95% CI: 1.15, 6.13) were significant, suggesting a synergistic impact on pre-frailty and frailty.
Pain, difficulty initiating sleep, and depressive symptoms are independent risk factors of frailty and may have a synergistic impact on frailty. Interventions should be developed to address these symptoms to reduce the adverse effects of frailty.