The Association Among Marital Status,Social Support And Frailty Of Middle-Aged And Older Adults

Background:The aging of China’s population has been further deepened.Physical degradation leads to generally poor health in older adults.The health gap in middle age is also growing as life expectancy increases and the prevalence of chronic diseases increases.Frailty is a highly age-related clinical syndrome that reflects the heterogeneity of health status and has emerged as a major public health problem.Frailty Index(FI)is one of the most commonly used tools for measuring frailty,which has widely recognized validity.Marital status largely determines the lifestyle and quality of life,which is closely related to health level of middleaged and older people.Social support may be the key to alleviating the adverse health effects of being single.Although a small number of studies indicated that marital status is associated with frailty among middle-aged and older adults,it is mainly explored through cross-sectional design.In addition,there is a lack of empirical analysis of the underlying mechanism of social support.Objectives:This study was aimed to describe the marital status,social support and frailty distribution among middle-aged and older adults in China,to analyze the relationship between marital status and frailty among middle-aged and older people,and to explore the role of social support in the relationship between marital status and frailty of middle-aged and older people.Then,it was suggested how to improve the health level and quality of life of middle-aged and older adults in China from the perspective of marital status and social support,with a view to providing reference for pension policies.Method:We used the follow-up data in 2015 and 2018 from a longitudinal study of middle-aged and older adults in China,entitled "China Health and Retirement Longitudinal Study".The target population of this study included middle-aged and older adults aged 45 and above.This study reflected marital status from three dimensions:marital state,marital satisfaction and marital transitions.Social support was measured from social activities and intergenerational support(social engagement and financial support by children and frequency of meeting with children).We also constructed FI to reflect frailty.We first described the distribution of the marital status,social support and FI of the middle-aged and older people;then the multivariate linear regression models of the lag dependent variables were established to explore the relationship between marital state and FI and the relationship between marital satisfaction and FI,the generalized estimation equation model(GEE)was established to explore the association between marital transitions and FI;finally,interactive items of marital status and social support was established to explore the role of social support in the association between marital status and FI.Statistical analyses were undertaken in STATA v.16 and SPSS v.26 and statistical significance was set at 0.05.Results:(1)Sample characteristics:The average FI of middle-aged and older people is 0.26(95%CI:0.257～0.261).About 88.19%were married and 11.81%were unmarried.The proportion of middle-aged and older adults who were very satisfied with marriage was the highest(47.92%).followed by those who were relatively satisfied with marriage(44.28%).with those who were dissatisfied with marriage having the lowest proportion(7.80%).The proportion of middle-aged and older adults who were married at both times was 84.85%and those who were unmarried to married was only 0.40%.About 67.10%had low-rated social engagement.The mean financial support by children in the past year was 5.680.04 CNY(95%CI:5.380.93～5,979.16).Almost 80.59%contacted with their children frequently.(2)The association among marital state,social support and FI:Compared to unmarried participants,married participants had lower FI(B=-0.022,β=-0.053,P<0.001).There is an interaction of married and contacted with children frequency on FI(B=0.029,β=0.099,P=0.001).(3)The association among marital satisfaction,social support and FI:compared with participants who were not satisfied with their marriage,those who were relatively satisfied with their marriage(B=-0.050,β=-0.191,P<0.001)and very satisfied with their marriage(B=-0.065,β=-0.249,P<0.001)had lower FI.There was an interaction of satisfied with relatively satisfied with marriage and high-rated social engagement on FI(B=0.024,β=0.064,P=0.017).(4)The association among marital transitions,social support and FI:comparison with married at both times participants,married to unmarried(OR=1.015,P=0.006)and unmarried at both times(OR=1.024,P<0.001)participants had higher FI;the interaction term between unmarried at both times and financial support by children was significant on FI(OR=0.998,P=0.036).Conclusions and recommendations:The frailty level of middle-aged and older adults is relatively high.Marital state,marital satisfaction and marital transitions affect the frailty level of middle-aged and older adults;social engagement,frequency of meeting with children and financial support by children play important roles in the relationship between marital status and frailty of middle-aged and older adults.Based on this,this study puts forward the following suggestions:(1)Improve the social security level of middle-aged and older adults who are unmarried and support their voluntary family restructuring;(2)Emphasize mediation and reduce conflicts between middle-aged and older couples and improve their marital satisfaction;(3)Establish rich and effective social communication networks through multiple channels to enhance the social participation of middle-aged and older people;(4)Encourage grown-up children to provide regular and stable financial support to their parents,and regularly visit and contact their parents regularly.