Abstract
OBJECTIVE: With the global population aging rapidly, understanding the factors influencing health outcomes in older adults is crucial. This study explores the longitudinal causal relationship between self-perceptions of aging and frailty and examines whether subjective cognitive decline mediated the associations. METHODS: The Brief-Aging Perceptions Questionnaire(B-APQ), the Frailty Phenotype Assessment Scale, and the Subjective Cognitive Decline Questionnaire were used to survey 619 community-dwelling older adults in Xinxiang, Henan, China, from March to October 2021 and from March to October 2023, respectively. A cross-lagged model was employed to analyze the potential mediating roles of subjective cognitive decline, controlling for confounders including age, gender, income, employment status, and education. RESULTS: (1) The cross-lagged model analysis revealed a bidirectional causal relationship between self-perceptions of aging and frailty (P < 0.001), with the effect of T1 self-perceptions of aging on T2 frailty (β = 0.109, SE = 0.038, P < 0.01) and the reverse effect (β = 0.129, SE = 0.041, P < 0.01). Further comparisons of the path coefficients indicated that the effect sizes of the two paths showed no statistical difference (χ(2) = 0.119, P > 0.05). (2) The longitudinal mediation analysis indicated that T1 self-perceptions of aging had an indirect effect on T2 frailty through subjective cognitive decline (indirect effect = 0.011). Concurrently, T1 frailty also indirectly influenced T2 self-perceptions of aging via subjective cognitive decline (indirect effect = 0.010), with all effects demonstrating statistical significance (P < 0.05). CONCLUSION: This study demonstrates a bidirectional causal relationship between self-perceptions of aging and frailty, with subjective cognitive decline identified as a mediating mechanism. These findings provide important guidance for future efforts aimed at reducing frailty rates among older adults in community settings.