Social frailty and physical resilience in elderly patients with motor cognitive risk syndrome: the multiple mediation effect of aging anxiety and fall alertness

Social frailty and physical resilience in elderly patients with motor cognitive risk syndrome: the multiple mediation effect of aging anxiety and fall alertness | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Social frailty and physical resilience in elderly patients with motor cognitive risk syndrome: the multiple mediation effect of aging anxiety and fall alertness Yingfei Cao, Rufan Li, Yao Ding, Mingkun Li, li-jun An This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8982822/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background Successful aging is a positive state of aging. Physical resilience, as a predictive indicator of future health and lifespan in the elderly, is a key entry point for them to achieve the goal of successful aging. Therefore, to promote successful aging among the elderly population, this study aimed to explore the sequential multiple mediating effects of aging anxiety and fall alertness between social frailty and physical resilience in elderly patients with motor cognitive risk syndrome(MCR). Methods A questionnaire survey was conducted among 800 elderly patients aged 65 and above with MCR from 11 Class-A grade-3 general hospitals in Shaanxi, Shanxi, Hunan, and Guangdong Provinces, China, using convenience sampling. The Anxiety about Aging Scale (AAS), the Self-Awareness of Falls in Elderly scale (SAFE), the Social Frailty Scale 8-item (SFS-8), and the Physical Resilience Instrument for Older Adults (PRIFOR) were used to measure the variables. Sequential multiple mediating analysis was conducted using the SPSS macro PROCESS 4.0 to evaluate the potential mediating roles of aging anxiety and fall alertness. Results Social frailty, aging anxiety, fall alertness, and physical resilience were significantly correlated( P < 0.01). Social frailty was not only directly related to the physical resilience of elderly patients with MCR(effect =-0.526;Standard error = 0.094; 95%CI: LL=-0.711, UL=-0.34), and also through the independent mediating effect of aging anxiety (effect =-0.285; Standard error = 0.042; 95%CI:LL=-0.371, UL=-0.206), the independent mediating effect of fall alertness (effect=-0.091;Standard error = 0.025;95%CI:LL=-0.145,UL=-0.047), the chain mediating effect between aging anxiety and fall alertness (effect=-0.094;Standard error = 0.019; 95%CI:LL=-0.134,UL=-0.058) was associated with physical resilience. Conclusions Studies have shown that the aging anxiety and fall alertness of elderly patients with MCR in China can mediate the connection between social frailty and physical resiliency. This suggests that it may become a key target for future intervention measures aimed at enhancing the physical resilience of the elderly and promoting successful aging. Clinical trial number: Not applicable. Aged Motor cognitive risk syndrome Physical resilience Social frailty Aging Anxiety Fall alertness Multiple mediation effect Figures Figure 1 1. Introduction Motoric Cognitive Risk Syndrome is a prodromal state of dementia characterized by the coexistence of slow gait speed and subjective cognitive complaints [ 1 ] . MCR is not only closely related to multiple chronic comorbidities such as hypertension, diabetes, stroke, and sarcopenia, but also significantly increases the risk of adverse health outcomes such as falls, functional disability, and death. Studies have shown that MCR has reversibility and intervention potential. Therefore, MCR is regarded as a key target for the early prevention and control of dementia. It can accurately identify high-risk groups and implement effective prevention and control strategies, which is of great significance for delaying the occurrence of the disease and improving the outcome of healthy aging. Physical resilience refers to the ability of individuals to maintain or restore the stability of bodily functions and homeostasis in the face of age-related injuries, diseases,and other physiological and psychological stressors [ 2 ] . Studies have shown that a high level of physical resilience can help elderly individuals effectively cope with health challenges and maintain their functional independence, thereby delaying the frailty process of the elderly group, significantly improving the healthy life span of the elderly group, and reducing the rate of disability, hospitalization, and mortality [ 3 – 5 ] . Studies have shown that physical resilience can effectively predict the incidence of adverse events in patients with Alzheimer's disease and other dementia-like diseases [ 6 ] , and improving physical resilience in the elderly has been regarded as a key strategy to promote successful aging. Therefore, understanding the current status and influencing factors of physical resilience in elderly patients with MCR is crucial in enhancing patients' ability to stabilize their internal balance and achieve successful aging. 1.1 social frailty and physical resilience For example, social frailty encompasses a comprehensive state characterized by a lack of social resources, a reduced social network scale, decreased social participation, and a decline in social role self-management ability [ 7 ] . Relevant research surveys have shown that the total prevalence of social frailty among the elderly worldwide is approximately 23.9% [ 8 ] . Numerous studies have demonstrated that social frailty is strongly linked to various adverse outcomes. Social frailty can not only weaken the physical function of patients, but also have a negative impact on their cognitive ability, and increase the risk of depression and death, leading to a significant decline in the quality of life of patients [ 9 ] . Existing studies have confirmed that patients with social frailty have a lower level of physical resilience and are more likely to develop motor cognitive risk syndrome [ 3 , 8 ] . However, the underlying mechanism of the effect of social frailty on physical resilience in elderly patients with MCR remains unclear. Therefore, the aim of this study was to investigate the underlying mechanisms between social frailty and physical resilience in an elderly Chinese MCR population. 1.2 Social frailty, physical resilience, aging anxiety, and fall alertness Aging anxiety refers to the concern and fear that individuals experience about a series of negative changes that may occur during the aging process, such as physical function decline, cognitive decline, and social role loss [ 10 ] . Previous studies have shown that this factor is significantly negatively correlated with physical resilience [ 11 – 12 ] . Elderly patients who maintain an optimistic attitude and actively participate in social activities tend to be better at regulating their emotions. Their degree of aging anxiety is lighter, and they can maintain good body function and maintain homeostasis. Studies have shown that social frailty can exacerbate negative emotions such as anxiety and depression in elderly patients, and seriously affect the quality of life of patients [ 13 – 14 ] . Given the association of aging anxiety with social frailty and physical resilience, social frailty in older adults may reduce their physical resilience by increasing their aging anxiety. Therefore, this study aimed to examine whether aging anxiety plays a mediating role in the relationship between social frailty and physical resilience. Previous studies have shown that fall alertness may play a mediating role in the association between social frailty and physical resilience [ 15 – 16 ] . Falls are a significant issue among older adults worldwide. Globally, people aged 65 years and older are at a risk of falling of up to 30% each year [ 17 – 18 ] . Fall alertness is a state in which individuals remain highly alert to fall-related threats in their environment, often manifesting as functional behavioral adaptations, such as avoiding specific activities and adopting a cautious gait [ 13 ] . A study of 4,559 Japanese older adults showed that socially frail older adults were less alert to falls and more likely to experience falls [ 19 – 20 ] . At the same time, aging anxiety is significantly negatively correlated with fall alertness [ 21 – 22 ] , and the higher the anxiety level of elderly patients, the higher the fall risk. Therefore, we hypothesized that aging anxiety may affect fall alertness and that fall alertness itself may serve as a potential mediator between social frailty and physical resilience in elderly patients. According to the three-factor model of successful aging, physical health, mental health, and active social participation are the three key elements of successful aging [ 23 ] . Therefore, psychosocial factors and behavioral patterns are key mechanisms in determining the level of physical resilience and successful aging. Based on this, this study considers aging anxiety and fall alertness as potential mediating variables in the relationship between social frailty and physical resilience. 1.3 The current study Based on the above empirical findings and theoretical support, this study aims to explore the potential mechanism of association between social frailty and physical resilience in elderly patients with MCR. Specifically, this study was analyzed using a sequential multiple mediation model, in which aging anxiety and fall alertness served as mediating variables. The following hypotheses were proposed: (1) Social frailty is negatively correlated with physical resilience in elderly patients with MCR; (2) Aging anxiety and fall alertness respectively mediated the relationship between social frailty and physical resilience; (3) There was a sequential mediation model, that is, social frailty leads to decreased social participation, which in turn affects fall alertness and ultimately reduces physical resilience. 2. Methods 2.1 Study design and participants From October 2025 to January 2026, the convenience sampling method was used to select elderly patients with MCR from 4 Class-A grade-3 general hospitals in Shaanxi Province, 2 Class-A grade-3 general hospitals in Shanxi Province, 3 Class-A grade-3 general hospitals in Hunan Province, and 2 Class-A grade-3 general hospitals in Guangdong Province as the participants. The inclusion criteria were as follows: (1) age ≥ 65 years old, (2) subjects met the diagnostic criteria of motor cognitive risk syndrome in the Chinese expert consensus on Health management of motor cognitive risk syndrome in the elderly (2025) [ 1 ] , (3) elderly patients with MCR and their families voluntarily participated in this study with informed consent. The exclusion criteria were as follows: (1) having experienced a traumatic event within 6 months, such as the death of a relative or friend, natural disaster, or sudden accident; (2) severe audio-visual impairment or psychiatric history; (3) those who were participating in other similar investigations. The sample size calculation for this study followed the guidelines proposed by Kline [ 24 ] , which recommended that the sample size should be 10 to 20 times the number of study variables, and since this study involved 66 variables and the invalid questionnaire rate was 20%, the required sample size was estimated to be 792 to 1584 participants. 2.2 Research instruments (1) General Information Questionnaire The questionnaire was self-designed by the researchers and included information on gender, age, smoking, drinking alcohol, education attainment, occupation, main economic source, marital status, Current cohabitation situation, frequency of social activity participation, C-type personality, sedentary time, sleep quality, coexistence of chronic diseases, and pain degree. (2) Anxiety about Aging Scale(AAS) The scale was developed by Lasher and Faulkender et al. [ 25 ] in 1993 and translated into Chinese by Liu Yune et al. [ 26 ] in 2012. The scale consisted of 20 items in four dimensions: fear of the elderly, psychological worry about aging, physical worry, and fear of loss. Respondents were asked to rate each item on a 4-point Likert scale, ranging from 1 (very consistent) to 4 (not at all consistent). Negative items, 2, 5, 6, 8, 9, 14, 17, and 20, were reversed. Overall scale scores ranged from 20 to 80, with higher scores indicating greater anxiety about aging. The Cronbach's alpha of the original scale ranged from 0.69 to 0.78, and the internal consistency reliability of the Chinese version of AAS was 0.80. (3) The Self-Awareness of Falls in Elderly scale(SAFE) The scale was developed by SHYU et al. [ 27 ] based on interviews with the elderly at high risk of falling and a literature review. The scale included four dimensions: activity safety and environmental alertness, physical function alertness, drug alertness, and cognitive behavior alertness, with a total of 21 items. The scale uses Likert5 grading scoring method, of which 15 items range from 1 to 5 points, 1 points means strongly agree, 5 points means strongly disagree, the other 6 items are reverse scoring, the total score is 21 to 105 points, the higher the score, the better the fall alertness, 54 points is the cut-off value, when the total score is lower than 54 points, The results indicate that the elderly are less alert to fall. (4) The Social Frailty Scale 8-item(SFS-8) The scale is a social frailty scale developed by Pek et al. [ 28 ] based on Bunt's conceptual framework of social frailty, published in 2020. This scale consists of a three-factor structure, including social resources, social activities, and economic resources, as well as the satisfaction of social needs, with a score range of 0 to 8 points. The score of non-social frailty was 0–1, the score of pre-social frailty was 2–3, and the score of social frailty was 4–8. (5) The Physical Resilience Instrument for Older Adults(PRIFOR) It was compiled by Hu et al. [ 29 ] and translated into Chinese by Li Jiaxin et al. [ 30 ] , including three dimensions: positive thinking (4 items), coping and adjusting lifestyle (7 items), belief and hope (5 items). The 5-point Likert scale was used to score responses from "strongly disagree to strongly agree", and the total score ranged from 16 to 80 points, with higher scores indicating higher levels of PR. The Cronbach's alpha coefficient of the scale was 0.94. 2.3 Data collection The researchers input the relevant content of the scale and questionnaire into the questionnaire Star to generate a two-dimensional code, which was set as a mandatory requirement for each question to prevent missing and random filling. Unified instructions were used to explain the purpose and precautions of the questionnaire in the WeChat work group, and a two-dimensional code was shared with the respondents to scan and complete the questionnaire. The survey data were collected by the questionnaire star program and exported in Excel form. There were 880 questionnaires, and 800 valid responses were retained after thorough review by two individuals, yielding a valid response rate of 90.9%. 2.4 Statistical analyses In this study, SPSS 26.0 was used for statistical analysis of the data, and the measurement data were described by mean ± standard deviation. The count data were described in terms of frequency and percentage. Spearman correlation analysis was used to investigate the relationship between aging anxiety, fall alertness, social frailty, and physical resilience. The Harman’s single-factor test was used to verify the common method bias; The multiple mediating effect test was conducted using Model 6 in the SPSS macro Process4.0 program (with 5,000 samples drawn using the Bootstrap method). The inspection level is α = 0.05. The P-value indicates the level of statistical significance. A P-value less than 0.05 indicates that the result is statistically significant. 3 Results 3.1 Characteristics of samples Table 1 presents the sample characteristics, including demographic information about the participants. In our study, 41.38% of the elderly lived with their spouses. There was little difference in the number of elderly people living alone (16.38%), living with their children (19.00%), living with their spouses and children (16.50%), and living in elderly care institutions (6.75%). 71.25% of the elderly have spouses still alive, while the rest of the elderly either have deceased spouses (14.25%), are divorced (13.63%), or are unmarried (0.88%). The number of elderly people with a C-type personality (62.38%) and an educational level of primary school (62.13%) is not significantly different from the number of elderly people who sit for 6 hours or more per day (62.75%). Most elderly people currently do not smoke or drink alcohol, accounting for 61.25% and 69.63% respectively. Table 1 The characteristics of the sample (N = 800) Variables Category N Percentage(%) Gender Male 501 62.63 Female 299 37.38 Age 60ཞ<70 years old 228 28.5 70ཞ<80 years old 312 39 80ཞ90 years old 7 0.88 smoking No 490 61.25 Yes 310 38.75 Drinking alcohol No 557 69.63 Yes 243 30.38 Educational attainment Illiterate 71 8.88 Primary school 497 62.13 Junior high school 124 15.5 High school/technical secondary school 97 12.13 Bachelor's degree/Junior college 4 0.5 Master's degree or above 7 0.88 occupation on the job 3 0.38 retire 204 25.5 farming 403 50.38 other 190 23.75 Main economic sources pension 213 26.63 Child support 351 43.88 Spouse support 5 0.63 Government subsidies/subsistence allowances 75 9.38 Personal savings/labor income 149 18.63 other 7 0.88 Marital Status Married 570 71.25 Divorced 109 13.63 widowed 114 14.25 unmarried 7 0.88 Current cohabitation situation Living alone 131 16.38 Live with one's spouse 331 41.38 Live with children 152 19 Live with one's spouse and children 132 16.5 Living in a nursing home 54 6.75 Frequency of social activity participation Almost every day 171 21.38 Several times a week 138 17.25 Several times a month 244 30.5 Seldom or never 247 30.88 C-type personality No 301 37.63 Yes 499 62.38 Sedentary time >6h/d 502 62.75 5 149 18.63 Degree of pain No pain 127 15.88 Intermittent pain 600 75 Persistent pain 73 9.13 Taking physical resilience as the dependent variable and each factor as the independent variable, a multiple linear regression analysis was conducted. The results showed that age, educational attainment, current cohabitation situation, frequency of social activity participation, C-type personality, sedentary time, sleep quality, and coexistence of chronic diseases were all influencing factors of physical resilience in the elderly (P < 0.05) (Table 2 ). Table 2 Multiple linear regression analysis ofphysical resilience in older people (N = 800) Variables β SE t P age -0.447 0.567 -9.072 0.000** smoking 0.002 0.588 0.058 0.953 Drinking alcohol -0.053 0.622 -1.709 0.088 Educational attainment 0.158 0.446 3.658 0.000** Current cohabitation situation -0.167 0.239 -5.579 0.000** Frequency of social activity participation -0.33 0.481 -5.631 0.000** C-type personality -0.128 0.573 -4.213 0.000** Sedentary time 0.246 0.553 8.429 0.000** Sleep quality -0.221 0.354 -7.425 0.000** Comorbidity of chronic diseases -0.161 0.253 -5.419 0.000** ** P < 0.01 3.2 Descriptive Analysis and Correlations of Social frailty, physical resilience, aging anxiety, and fall alertness Table 3 lists the descriptive statistics and correlations of the examined variables. The average score of physical resilience in elderly patients with MCR (40.35 ± 9.17) is below average; the average score of social frailty is 2.72 ± 2.60, and the average scores of aging anxiety and fall alertness are 58.24 ± 11.98 and 51.83 ± 14.98, respectively. The results of the correlation analysis were consistent with our expected hypothesis,and all analysis results were statistically significant at the P < 0.01(two-tailed) level. Firstly, Social frailty was significantly negatively correlated with physical resilience (r = -0.398), aging anxiety ( r = 0.351), and fall alertness ( r = -0.343). Secondly, physical resilience was negatively correlated with aging anxiety (r = -0.597) and fall alertness ( r = 0.557). Aging anxiety was negatively correlated with fall alertness ( r =-0.611). Table 3 Mean, standard deviation and correlation analysis of Social frailty urinary incontinence, physical resiliencesubjective well-being, aging anxietysocial participation, and fall alertnesssleep quality Variables Mean ± SD physical resilience Social frailty aging anxiety fall vigilance physical resilience 40.35 ± 9.17 1 Social frailty 2.72 ± 2.60 -0.398** 1 aging anxiety 58.24 ± 11.98 -0.597** 0.351** 1 fall vigilance 51.83 ± 14.98 0.557** -0.343** -0.611** 1 All values in the table represent Spearman's rank correlation coefficients (r); ** P < 0.01 (two-tailed) 3.3 Mediating analysis of aging anxiety and fall alertness Twelve factors with characteristic roots greater than 1 were obtained by using Harman’s single-factor analysis method. The variation explained by the first factor was 35.33%, indicating that there was no serious common method bias in this study. We used the bootstrap method to explore the role of aging anxiety and fall alertness in the relationship between Social frailty and physical resilience in the respondent group. The age, educational attainment, current cohabitation situation, frequency of social activity participation,C-type personality, sedentary time, sleep quality, and coexistence of chronic diseases of the respondents were controlled (Table 4 ). The results showed that Social frailty was positively correlated with aging anxiety ( β = 0.278, P < 0.01) and negatively correlated with fall alertness ( β = -0.132, P < 0.01). Aging anxiety was negatively correlated with fall alertness ( β =-0.491, P < 0.01). We found that, after considering all other variables, aging anxiety (β = -0.291, P < 0.01) and fall alertness ( β = 0.196, P < 0.01) were significant predictors of physical resilience. When the regression analysis included aging anxiety and fall alertness, the relationship between Social frailty and physical resilience remained significant ( β = -0.149, P < 0.01). Table 4 Sequential multiple mediating models between aging anxietyurinary incontinence and physical resiliencesubjective well-being in older adults Predictors aging anxiety fall alertness physical resilience β B t β B t β B t Age 0.372 5.598 7.224** -0.097 -1.821 -2.041* -0.262 -3.018 -6.194** Educational attainment -0.143 -1.935 -3.186** 0.05 0.842 1.235 0.09 0.933 2.51* Current cohabitation situation 0.158 1.651 5.068** -0.041 -0.534 -1.445 -0.088 -0.702 -3.488** Frequency of social activity participation 0.257 2.754 4.182** -0.056 -0.748 -1.008 -0.213 -1.742 -4.306** C-type personality -0.026 -0.632 -0.829 0.008 0.261 0.307 -0.098 -1.854 -4.002** Sedentary time -0.037 -0.914 -1.196 0.07 2.183 2.559* 0.186 3.531 7.569** Sleep quality 0.154 2.391 4.942** -0.108 -2.090 -3.817 -0.126 -1.494 -4.961** Comorbidity of chronic diseases 0.093 1.031 2.911** -0.054 -0.758 -1.911 -0.057 -0.488 -2.252* Social frailty 0.278 1.281 8.738** -0.132 -0.759 -4.437** -0.149 -0.526 -5.569** aging anxiety -0.491 -0.614 -15.489** -0.291 -0.223 -9.026** fall alertness 0.196 0.120 6.178** R 2 0.268 0.419 0.541 F 32.161 56.810 84.273 β standardized coefficients, B unstandardized coefficients * P < 0.05 ** P < 0.01 The sequential mediating analysis results for the relationship between aging anxiety, fall alertness, social frailty, and physical resilience are shown in Fig. 1 and Table 5 . The overall impact of Social frailty on physical resilience was significant ( P < 0.01), indicating that the level of fall alertness in elderly patients with MCR decreased significantly when Social frailty was severe. Furthermore, all three indirect and direct paths are also important. Specifically, the first direct pathway is that aging anxiety significantly mediates the impact of Social frailty on physical resilience, with an effect size of -0.285; The second direct approach is that fall alertness significantly mediates the impact of Social frailty on physical resilience, with an effect size of -0.091. The third indirect approach is that the impact of Social frailty on physical resilience is significantly mediated through aging anxiety and fall alertness, with an effect size of -0.094. Furthermore, aging anxiety has a significant direct impact on fall alertness, with an effect size of -0.614. These results suggest that aging anxiety and fall alertness partially mediate the relationship between Social frailty and physical resilience. Table 5 Hypothesized serial mediation model of social participationaging anxiety and sleep qualityphysical resilience between urinary incontinenceSocial frailty andphysical resilience subjective well-being Pathway Effect SE BootLLCI BootULCI Total effect (C) -0.996 0.101 -1.194 -0.798 Direct effect (C’) -0.526 0.094 -0.711 -0.34 a1 1.281 0.147 0.993 1.568 a2 -0.759 0.171 -1.095 -0.423 a3 -0.614 0.04 -0.692 -0.536 b1 -0.223 0.025 -0.271 -0.174 b2 0.12 0.019 0.082 0.158 Indirect effects Total indirect effects (CD’) -0.471 0.052 -0.574 -0.371 Indirect 1 -0.285 0.042 -0.371 -0.206 Indirect 2 -0.091 0.025 -0.145 -0.047 Indirect 3 -0.094 0.019 -0.134 -0.058 Abbreviation: Indirect 1, Social frailty→aging anxiety→physical resilience; Indirect 2, Social frailty→fall alertness→physical resilience; Indirect 3, Social frailty→aging anxiety→fall alertness→physical resilience. BootLLCI Bootstrapping lower limit confidence interval, BootULCI Bootstrapping upper limit confidence interval, SE Standard error, Effect Standardized regression coefficient 4 Discussion This study explored the impact of social frailty on the physical resilience of elderly patients with MCR, using aging anxiety and fall alertness as mediating variables for analysis. The research results show that social frailty not only directly and negatively affects physical resilience, but also has an indirect impact through two independent mediating pathways and the linked mediating pathways of aging anxiety and fall alertness.These findings provide a crucial theoretical basis for enhancing social frailty in elderly patients with MCR, and have significant practical implications for improving the physical, psychological, and social resources of patients, promoting physical resilience, and achieving successful aging. 4.1 The direct impact of social decline on physical resilience Descriptive analysis revealed that the total social frailty score of elderly patients with MCR was 2.719 ± 2.602, which was higher than that reported in relevant studies by Zare et al. [ 31 ] . The reason for the relatively high score may be related to the fact that elderly patients with MCR have a reduced frequency of social activity participation due to declines in physical function and bradykinesia. At the same time, symptoms such as memory decline and slow response lead to a reduction in patients' social roles and self-worth in social activities, generating a sense of stigma, which in turn triggers negative emotions such as embarrassment, anxiety, and low self-esteem, causing them to actively avoid social activities [ 8 ] . Therefore, the core symptoms of MCR highly overlap with the contributing factors of social frailty and exacerbate each other. In addition, the total score for physical resilience was only 40.354 ± 9.173, which was lower than that reported in relevant studies [ 29 ] . The low score may be related to the decline in physiological functions of elderly patients with MCR, the gradual decrease in their overall recovery ability against stressors, and the decline in physical resilience. In addition, due to the patient's memory decline, their self-management compliance is poor, which leads to an accelerated decline in physiological reserve and further aggravates the wear and tear on physical resilience. Elderly patients with MCR are often accompanied by emotions such as anxiety and depression. Negative emotions not only accelerate the depletion of physiological reserves but also deprive elderly patients with MCR of their motivation and willpower, ultimately leading to a decline in physical resilience. This study found that social frailty has a significant direct negative impact on the physical resilience of elderly patients with MCR, with a direct effect value of -0.526, accounting for 52.811% of the total effect. Elderly patients with MCR often undergo a complex transformation process from a relatively healthy state to a coexistence of frailty and cognitive decline. This stage of health transition is characterized by a decline in multiple system functions and a reduction in physiological reserves, often accompanied by a significant weakening of the body's resilience. Against the backdrop of an aging population and the coexistence of multiple diseases, social frailty, as a cumulative state of resource scarcity, constitutes a persistent source of physical and psychological stress. If there is a lack of effective social support and health service resources, such multiple stress factors will significantly increase the risk of adverse health outcomes for elderly patients with MCR, thereby directly hindering the maintenance and improvement of their physical resilience. According to the multidimensional successful aging model of bio-psycho-society [ 32 ] , individuals, through active psychological and behavioral adaptation, mobilize internal and external resources to achieve a dynamic balance of the functions across the three dimensions. Social frailty consumes the physiological resources (neuromuscular function, metabolic reserves), psychological resources (stress adaptability), and social resources (emotional and material support) of elderly patients with MCR. Under the multi-dimensional interaction, it directly leads to a decline in mobility and an increase in fatigue, thereby significantly weakening their physical resilience. Existing research also indirectly suggests that social frailty may intensify the frailty-cognitive impairment vicious cycle in MCR syndrome, weaken the intrinsic motivation of patients to participate in rehabilitation training and maintain physical functions, and thereby damage their overall physiological recovery potential [ 8 ] . Therefore, the results of this study indicate that personalized intervention measures aimed at delaying or improving social frailty in elderly patients with MCR can serve as an effective approach to enhance their physical resilience and promote successful aging outcomes. 4.2 The mediating role of aging anxiety The analysis further determined the mediating role of aging anxiety in the relationship between social frailty and physical resilience in elderly patients with MCR. The mediating effect value was − 0.285, accounting for 28.614% of the total effect. From the perspective of the multi-dimensional successful aging model of biological-psychological-society, aging anxiety, as the comprehensive concern of elderly patients with MCR regarding the decline of physical and mental functions and the transformation of social roles during the aging process [ 33 – 34 ] , further reflects the dynamic interaction state among biological aging, psychological adjustment, and social adaptation. Moreover, the enhanced inflammatory response, suppressed immune function, and neuroendocrine disorders caused by anxiety and depression can lead to the accelerated consumption of physiological reserves, which is an important psychosocial mechanism affecting the recovery and maintenance of physical functions. Aging anxiety makes it difficult for elderly patients with MCR to effectively integrate resources and adjust behaviors, constituting an important internal obstacle to enhancing physical resilience. Future intervention can start from multiple aspects, such as reducing maladaptive anxiety, enhancing physiological and psychological coordination ability, and rebuilding social support networks, to alleviate the negative impact of aging anxiety, and thereby promote the physical function recovery and overall healthy development of elderly patients with MCR. 4.3 The mediating role of fall alertness The research found that fall alertness has a significant mediating effect between social frailty and physical resilience in elderly patients with MCR, with a mediating effect value of -0.091, accounting for 9.137% of the total indirect effect. This finding is consistent with the conclusions of previous studies on falls in the elderly [ 35 ] . Individuals with a high level of fall alertness usually take proactive preventive actions (such as balance training, environmental improvement, and seeking professional support) to reduce their own fall risk, thereby maintaining or improving physical function [ 35 – 36 ] . Based on the multidimensional successful aging model of bio-psycho-society, a higher level of fall alertness enables individuals to integrate their own abilities and external support during the aging process, maintain social activities, and effectively enhance their physical resilience. Future interventions should be based on a multidimensional model of successful aging that encompasses biological, psychological, and social aspects. Through integrated strategies, such as cognitive-behavioral guidance, environmental adaptation, and social support reinforcement, a positive and scientifically informed alertness pattern can be developed, promoting physical recovery and overall functional maintenance in elderly patients with MCR. 4.4 The multiple mediating effect between aging anxiety and fall alertness The results of this study reveal the multiple mediating effect of aging anxiety and fall alertness in elderly patients with MCR between social frailty and physical resilience, with a mediating effect value of -0.094. Relevant studies have shown that aging anxiety and fall alertness are important factors affecting the physical and mental health and functional recovery of the elderly [ 37 – 39 ] . According to the successful aging model, the realization of successful aging depends on an individual's ability to maintain balance and integration among multi-dimensional resources. Individuals with high levels of aging anxiety, in the context of insufficient social resources, are prone to worry about functional decline, which in turn intensifies their perception and alertness to the risk of falls. This prompts elderly patients with MCR to actively adjust to preserve and acquire new resources (such as enhancing balance training and seeking social support). Thus, it promotes the accumulation and development of physical resilience in multiple dimensions, including biological, psychological, and social. This dynamic process reshapes the physical and mental challenges faced by elderly patients with MCR in a state of social frailty, potentially enhancing their physical resilience through behavioral adjustments. This suggests that in the intervention of elderly patients with MCR, the negative impact of social frailty on physical function can be mitigated by systematically assessing and managing the level of aging anxiety and providing a reasonable understanding of the risk of falls, thereby enhancing their physical resilience. Future research can develop or integrate comprehensive physical resilience assessment tools for the elderly that simultaneously evaluate social frailty, aging anxiety, and fall alertness, enabling early risk stratification and targeted preventive intervention measures. The emphasis is on building an intervention team composed of geriatricians, rehabilitation therapists, psychotherapists, and social workers, and designing a multidimensional, integrated intervention plan that spans social psychology to physiological functions [ 40 – 46 ] . By regulating social frailty, aging anxiety, and fall alertness in elderly patients with MCR, their physiological and psychological reserves are enhanced, breaking the frailty cycle and improving physical resilience. At the same time, it is necessary to enhance interdisciplinary cooperation, promote the transformation of intervention programs from clinical practice to community-based practice, and provide replicable and scalable systematic solutions for achieving "successful aging". 5. Limitations​ This study employed a cross-sectional design and was unable to establish a causal relationship among the variables. Future research can adopt a longitudinal study design to more rigorously examine the causal paths and dynamic interactions among the variables. The samples were derived solely from hospitals and failed to encompass elderly patients with MCR in various care settings, including communities and elderly care institutions, which limited the generalizability of the research conclusions. Future studies can incorporate diverse elderly subgroups (such as those with different living arrangements and cultural backgrounds) for multi-center and large-sample surveys to enhance the universality of the results. All the data in this study were collected using the patient Self-rating Scale, and there is a potential for information bias. Future research should adopt a mixed-methods approach, integrating subjective scales, objective evaluations, and qualitative interviews to enhance the accuracy of self-reported data. ​6. Conclusion This study, through a survey of 800 elderly patients with MCR, verified the independent and chain mediating roles of aging anxiety and fall alertness in the relationship between social frailty and physical resilience, and found that social frailty was significantly negatively correlated with physical resilience. The research results show that aging anxiety and fall alertness are important mediating variables affecting social frailty in elderly patients with MCR. Clinical workers and rehabilitation intervention designers need to systematically pay attention to the accompanying aging anxiety and fall risk perception when dealing with the social frailty problem of elderly patients with MCR. And through multi-dimensional intervention strategies, anxiety is simultaneously alleviated, and a positive alertness and adaptation pattern is guided to be established, thereby more effectively promoting the recovery and maintenance of patients' physical functions and enhancing their overall rehabilitation level. Abbreviations SFS-8 Social Frailty Scale 8-item AAS Anxiety about Aging Scale SAFE Self-Awareness of Falls in Elderly scale PRIFOR Physical Resilience Instrument for Older Adults MCR Motoric Cognitive Risk Syndrome Declarations Ethical Approval and Consent to Participate ： This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Review Committee of the Tangdu Hospital of Air Force Medical University(Ethics No.: K202602-11). Written informed consent was obtained from all individual participants included in the study. Consent for publication: Not applicable. Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' contributions: Conceptualization, Y.C. and L.A. (Li-jun An); Methodology, R.L. and Y.C.; Formal Analysis, R.L.and Y.C.; Investigation, R.L.,Y.C.,Y.D.,and M.L.; Writing Original Draft Preparation, R.L.,Y.C.; Writing Review & Editing, L.A. (Li-jun An); Supervision, L.A. (Li-jun An). All authors have read and agreed to the published version of the manuscript. Acknowledgements: Not applicable. References Ma L, Xing Y, Zhang L, Chen B, Zhang C, Yu P. Chinese expert consensus on health management of motoric cognitive risk syndrome in the elderly (2025). 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Chinese.https://doi.org/10.7666/d.y2110939 Pek K, Chew J, Lim JP, Yew S, Tan CN, Yeo A, Ding YY, Lim WS. Social Frailty Is Independently Associated with Mood, Nutrition, Physical Performance, and Physical Activity: Insights from a Theory-Guided Approach. Int J Environ Res Public Health. 2020;17(12). https://doi.org/10.3390/ijerph17124239 . Hu FW, Lin CH, Yueh FR, Lo YT, Lin CY. Development and psychometric evaluation of the Physical Resilience Instrument for Older Adults (PRIFOR). BMC Geriatr. 2022;22(1):229. https://doi.org/10.1186/s12877-022-02918-7 . Li J, Liu J, Liu Z, Wang Y, Shang Y, Li Y, Liu F. Revision of simplified Chinese version of the Physical Resilience Instrument for Older Adults and its reliability and validity test. Military Nurs. 2024;41(10):48–51. https://doi.org/10.3969/j.issn.2097-1826.2024.10.012 . Chinese. Zare H, Tagharrobi Z, Zare M. Cross-cultural adaptation and psychometric evaluation of the social frailty scale in Iranian older adults. 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J Frailty Aging. 2021;10(4):337–42. https://doi.org/10.14283/jfa.2021.27 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 03 Mar, 2026 Editor assigned by journal 03 Mar, 2026 Submission checks completed at journal 03 Mar, 2026 First submitted to journal 26 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8982822","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":600897258,"identity":"0f851655-1800-4cf6-8c67-f6256b7cb1cc","order_by":0,"name":"Yingfei Cao","email":"","orcid":"","institution":"空军军医大学唐都医院","correspondingAuthor":false,"prefix":"","firstName":"Yingfei","middleName":"","lastName":"Cao","suffix":""},{"id":600897259,"identity":"800b5a58-ce05-44eb-aa16-573cac5ecf0a","order_by":1,"name":"Rufan Li","email":"","orcid":"","institution":"空军军医大学唐都医院","correspondingAuthor":false,"prefix":"","firstName":"Rufan","middleName":"","lastName":"Li","suffix":""},{"id":600897260,"identity":"bbd63ca8-77c1-4afe-9547-8621172c27a1","order_by":2,"name":"Yao Ding","email":"","orcid":"","institution":"空军军医大学唐都医院","correspondingAuthor":false,"prefix":"","firstName":"Yao","middleName":"","lastName":"Ding","suffix":""},{"id":600897262,"identity":"15781e53-dc9c-4483-a7d3-39450fe8d90f","order_by":3,"name":"Mingkun Li","email":"","orcid":"","institution":"南华大学第一附属医院","correspondingAuthor":false,"prefix":"","firstName":"Mingkun","middleName":"","lastName":"Li","suffix":""},{"id":600897263,"identity":"ee5d2ef7-c664-4cc5-bf24-b7355e00dc13","order_by":4,"name":"li-jun An","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYBACNmaGBIMPBjX1+883HyBOCx97w4PCGRXHGBtuHEsgToscz8EHn3nOMDM2HMgxINJhEsmJG3jb2IB6zny88YbBTk63gaCWtGQDyTYZNmbm3s2WcxiSjc0OENSSk2Zg2MbGw8Zwdps0D8OBxG2EteR//5HYxizBw5DzjEgtPAcSDA6cYTaQYMhhI1ILe0OCYUPFsQQDiWPGlnMMiPCLfDNDgvEfg5oEA/7mhzfeVNjJEdSCAiR4iIwaZC2k6hgFo2AUjIIRAQCY5UIW3NHVSQAAAABJRU5ErkJggg==","orcid":"","institution":"空军军医大学唐都医院","correspondingAuthor":true,"prefix":"","firstName":"li-jun","middleName":"","lastName":"An","suffix":""}],"badges":[],"createdAt":"2026-02-27 03:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8982822/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8982822/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104273863,"identity":"06f3b945-52b6-4447-a1f6-4a19a7a2af20","added_by":"auto","created_at":"2026-03-10 00:45:03","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":51232,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSerial mediation models for Social frailty, physical resilience, aging anxiety, and fall alertness.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNote: Path coefficients were shown in the standardized regression coefficient. **\u003cem\u003eP\u003c/em\u003e\u0026lt;0.01\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8982822/v1/5c5a33ff1fb6a26a06cdb9f1.png"},{"id":104405413,"identity":"5a2ffe1f-6058-4ecf-9e45-81fcf49c3bd4","added_by":"auto","created_at":"2026-03-11 12:22:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1462874,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8982822/v1/03985f66-b260-4fe5-a8ac-ca3cf217b94b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Social frailty and physical resilience in elderly patients with motor cognitive risk syndrome: the multiple mediation effect of aging anxiety and fall alertness","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eMotoric Cognitive Risk Syndrome is a prodromal state of dementia characterized by the coexistence of slow gait speed and subjective cognitive complaints \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. MCR is not only closely related to multiple chronic comorbidities such as hypertension, diabetes, stroke, and sarcopenia, but also significantly increases the risk of adverse health outcomes such as falls, functional disability, and death. Studies have shown that MCR has reversibility and intervention potential. Therefore, MCR is regarded as a key target for the early prevention and control of dementia. It can accurately identify high-risk groups and implement effective prevention and control strategies, which is of great significance for delaying the occurrence of the disease and improving the outcome of healthy aging.\u003c/p\u003e \u003cp\u003ePhysical resilience refers to the ability of individuals to maintain or restore the stability of bodily functions and homeostasis in the face of age-related injuries, diseases,and other physiological and psychological stressors \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Studies have shown that a high level of physical resilience can help elderly individuals effectively cope with health challenges and maintain their functional independence, thereby delaying the frailty process of the elderly group, significantly improving the healthy life span of the elderly group, and reducing the rate of disability, hospitalization, and mortality \u003csup\u003e[\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Studies have shown that physical resilience can effectively predict the incidence of adverse events in patients with Alzheimer's disease and other dementia-like diseases \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e, and improving physical resilience in the elderly has been regarded as a key strategy to promote successful aging. Therefore, understanding the current status and influencing factors of physical resilience in elderly patients with MCR is crucial in enhancing patients' ability to stabilize their internal balance and achieve successful aging.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 social frailty and physical resilience\u003c/h2\u003e \u003cp\u003eFor example, social frailty encompasses a comprehensive state characterized by a lack of social resources, a reduced social network scale, decreased social participation, and a decline in social role self-management ability \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Relevant research surveys have shown that the total prevalence of social frailty among the elderly worldwide is approximately 23.9% \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Numerous studies have demonstrated that social frailty is strongly linked to various adverse outcomes. Social frailty can not only weaken the physical function of patients, but also have a negative impact on their cognitive ability, and increase the risk of depression and death, leading to a significant decline in the quality of life of patients \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Existing studies have confirmed that patients with social frailty have a lower level of physical resilience and are more likely to develop motor cognitive risk syndrome \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. However, the underlying mechanism of the effect of social frailty on physical resilience in elderly patients with MCR remains unclear. Therefore, the aim of this study was to investigate the underlying mechanisms between social frailty and physical resilience in an elderly Chinese MCR population.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Social frailty, physical resilience, aging anxiety, and fall alertness\u003c/h2\u003e \u003cp\u003eAging anxiety refers to the concern and fear that individuals experience about a series of negative changes that may occur during the aging process, such as physical function decline, cognitive decline, and social role loss \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Previous studies have shown that this factor is significantly negatively correlated with physical resilience \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Elderly patients who maintain an optimistic attitude and actively participate in social activities tend to be better at regulating their emotions. Their degree of aging anxiety is lighter, and they can maintain good body function and maintain homeostasis. Studies have shown that social frailty can exacerbate negative emotions such as anxiety and depression in elderly patients, and seriously affect the quality of life of patients \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Given the association of aging anxiety with social frailty and physical resilience, social frailty in older adults may reduce their physical resilience by increasing their aging anxiety. Therefore, this study aimed to examine whether aging anxiety plays a mediating role in the relationship between social frailty and physical resilience.\u003c/p\u003e \u003cp\u003ePrevious studies have shown that fall alertness may play a mediating role in the association between social frailty and physical resilience \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Falls are a significant issue among older adults worldwide. Globally, people aged 65 years and older are at a risk of falling of up to 30% each year \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e. Fall alertness is a state in which individuals remain highly alert to fall-related threats in their environment, often manifesting as functional behavioral adaptations, such as avoiding specific activities and adopting a cautious gait \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. A study of 4,559 Japanese older adults showed that socially frail older adults were less alert to falls and more likely to experience falls \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. At the same time, aging anxiety is significantly negatively correlated with fall alertness \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e, and the higher the anxiety level of elderly patients, the higher the fall risk. Therefore, we hypothesized that aging anxiety may affect fall alertness and that fall alertness itself may serve as a potential mediator between social frailty and physical resilience in elderly patients.\u003c/p\u003e \u003cp\u003eAccording to the three-factor model of successful aging, physical health, mental health, and active social participation are the three key elements of successful aging \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. Therefore, psychosocial factors and behavioral patterns are key mechanisms in determining the level of physical resilience and successful aging. Based on this, this study considers aging anxiety and fall alertness as potential mediating variables in the relationship between social frailty and physical resilience.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.3 The current study\u003c/h2\u003e \u003cp\u003eBased on the above empirical findings and theoretical support, this study aims to explore the potential mechanism of association between social frailty and physical resilience in elderly patients with MCR. Specifically, this study was analyzed using a sequential multiple mediation model, in which aging anxiety and fall alertness served as mediating variables. The following hypotheses were proposed: (1) Social frailty is negatively correlated with physical resilience in elderly patients with MCR; (2) Aging anxiety and fall alertness respectively mediated the relationship between social frailty and physical resilience; (3) There was a sequential mediation model, that is, social frailty leads to decreased social participation, which in turn affects fall alertness and ultimately reduces physical resilience.\u003c/p\u003e \u003c/div\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design and participants\u003c/h2\u003e \u003cp\u003eFrom October 2025 to January 2026, the convenience sampling method was used to select elderly patients with MCR from 4 Class-A grade-3 general hospitals in Shaanxi Province, 2 Class-A grade-3 general hospitals in Shanxi Province, 3 Class-A grade-3 general hospitals in Hunan Province, and 2 Class-A grade-3 general hospitals in Guangdong Province as the participants. The inclusion criteria were as follows: (1) age\u0026thinsp;\u0026ge;\u0026thinsp;65 years old, (2) subjects met the diagnostic criteria of motor cognitive risk syndrome in the \u003cb\u003eChinese expert consensus on Health management of motor cognitive risk syndrome in the elderly (2025)\u003c/b\u003e\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e, (3) elderly patients with MCR and their families voluntarily participated in this study with informed consent. The exclusion criteria were as follows: (1) having experienced a traumatic event within 6 months, such as the death of a relative or friend, natural disaster, or sudden accident; (2) severe audio-visual impairment or psychiatric history; (3) those who were participating in other similar investigations.\u003c/p\u003e \u003cp\u003eThe sample size calculation for this study followed the guidelines proposed by Kline \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e, which recommended that the sample size should be 10 to 20 times the number of study variables, and since this study involved 66 variables and the invalid questionnaire rate was 20%, the required sample size was estimated to be 792 to 1584 participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Research instruments\u003c/h2\u003e \u003cp\u003e \u003cb\u003e(1) General Information Questionnaire\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe questionnaire was self-designed by the researchers and included information on gender, age, smoking, drinking alcohol, education attainment, occupation, main economic source, marital status, Current cohabitation situation, frequency of social activity participation, C-type personality, sedentary time, sleep quality, coexistence of chronic diseases, and pain degree.\u003c/p\u003e \u003cp\u003e \u003cb\u003e(2) Anxiety about Aging Scale(AAS)\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe scale was developed by Lasher and Faulkender et al. \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e in 1993 and translated into Chinese by Liu Yune et al. \u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e in 2012. The scale consisted of 20 items in four dimensions: fear of the elderly, psychological worry about aging, physical worry, and fear of loss. Respondents were asked to rate each item on a 4-point Likert scale, ranging from 1 (very consistent) to 4 (not at all consistent). Negative items, 2, 5, 6, 8, 9, 14, 17, and 20, were reversed. Overall scale scores ranged from 20 to 80, with higher scores indicating greater anxiety about aging. The Cronbach's alpha of the original scale ranged from 0.69 to 0.78, and the internal consistency reliability of the Chinese version of AAS was 0.80.\u003c/p\u003e \u003cp\u003e \u003cb\u003e(3) The Self-Awareness of Falls in Elderly scale(SAFE)\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe scale was developed by SHYU et al. \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e based on interviews with the elderly at high risk of falling and a literature review. The scale included four dimensions: activity safety and environmental alertness, physical function alertness, drug alertness, and cognitive behavior alertness, with a total of 21 items. The scale uses Likert5 grading scoring method, of which 15 items range from 1 to 5 points, 1 points means strongly agree, 5 points means strongly disagree, the other 6 items are reverse scoring, the total score is 21 to 105 points, the higher the score, the better the fall alertness, 54 points is the cut-off value, when the total score is lower than 54 points, The results indicate that the elderly are less alert to fall.\u003c/p\u003e\u003cp\u003e \u003cb\u003e(4) The Social Frailty Scale 8-item(SFS-8)\u003c/b\u003e \u003c/p\u003e\u003cp\u003eThe scale is a social frailty scale developed by Pek et al. \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e based on Bunt's conceptual framework of social frailty, published in 2020. This scale consists of a three-factor structure, including social resources, social activities, and economic resources, as well as the satisfaction of social needs, with a score range of 0 to 8 points. The score of non-social frailty was 0\u0026ndash;1, the score of pre-social frailty was 2\u0026ndash;3, and the score of social frailty was 4\u0026ndash;8.\u003c/p\u003e \u003cp\u003e \u003cb\u003e(5) The Physical Resilience Instrument for Older Adults(PRIFOR)\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIt was compiled by Hu et al. \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e and translated into Chinese by Li Jiaxin et al. \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e, including three dimensions: positive thinking (4 items), coping and adjusting lifestyle (7 items), belief and hope (5 items). The 5-point Likert scale was used to score responses from \"strongly disagree to strongly agree\", and the total score ranged from 16 to 80 points, with higher scores indicating higher levels of PR. The Cronbach's alpha coefficient of the scale was 0.94.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Data collection\u003c/h2\u003e \u003cp\u003eThe researchers input the relevant content of the scale and questionnaire into the questionnaire Star to generate a two-dimensional code, which was set as a mandatory requirement for each question to prevent missing and random filling. Unified instructions were used to explain the purpose and precautions of the questionnaire in the WeChat work group, and a two-dimensional code was shared with the respondents to scan and complete the questionnaire. The survey data were collected by the questionnaire star program and exported in Excel form. There were 880 questionnaires, and 800 valid responses were retained after thorough review by two individuals, yielding a valid response rate of 90.9%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical analyses\u003c/h2\u003e \u003cp\u003eIn this study, SPSS 26.0 was used for statistical analysis of the data, and the measurement data were described by mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. The count data were described in terms of frequency and percentage. Spearman correlation analysis was used to investigate the relationship between aging anxiety, fall alertness, social frailty, and physical resilience. The Harman\u0026rsquo;s single-factor test was used to verify the common method bias; The multiple mediating effect test was conducted using Model 6 in the SPSS macro Process4.0 program (with 5,000 samples drawn using the Bootstrap method). The inspection level is α\u0026thinsp;=\u0026thinsp;0.05. The P-value indicates the level of statistical significance. A P-value less than 0.05 indicates that the result is statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Characteristics of samples\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the sample characteristics, including demographic information about the participants. In our study, 41.38% of the elderly lived with their spouses. There was little difference in the number of elderly people living alone (16.38%), living with their children (19.00%), living with their spouses and children (16.50%), and living in elderly care institutions (6.75%). 71.25% of the elderly have spouses still alive, while the rest of the elderly either have deceased spouses (14.25%), are divorced (13.63%), or are unmarried (0.88%). The number of elderly people with a C-type personality (62.38%) and an educational level of primary school (62.13%) is not significantly different from the number of elderly people who sit for 6 hours or more per day (62.75%). Most elderly people currently do not smoke or drink alcohol, accounting for 61.25% and 69.63% respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eThe characteristics of the sample (N\u0026thinsp;=\u0026thinsp;800)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e501\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60ཞ\u0026lt;70 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70ཞ\u0026lt;80 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80ཞ\u0026lt;90 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e253\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;90 years old\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e490\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e310\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrinking alcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e557\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational attainment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e497\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJunior high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school/technical secondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor's degree/Junior college\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaster's degree or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eoccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eon the job\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eretire\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efarming\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e403\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain economic sources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChild support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpouse support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernment subsidies/subsistence allowances\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePersonal savings/labor income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e570\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ewidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eunmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent cohabitation situation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiving alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLive with one's spouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e331\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLive with children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLive with one's spouse and children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiving in a nursing home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of social activity participation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlmost every day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeveral times a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeveral times a month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeldom or never\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC-type personality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e301\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e499\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSedentary time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;6h/d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e502\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;6h/d\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCoexistence of chronic diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDegree of pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntermittent pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e600\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePersistent pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTaking physical resilience as the dependent variable and each factor as the independent variable, a multiple linear regression analysis was conducted. The results showed that age, educational attainment, current cohabitation situation, frequency of social activity participation, C-type personality, sedentary time, sleep quality, and coexistence of chronic diseases were all influencing factors of physical resilience in the elderly (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple linear regression analysis ofphysical resilience in older people (N\u0026thinsp;=\u0026thinsp;800)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.447\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-9.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.588\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.953\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrinking alcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.622\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.709\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational attainment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.446\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.658\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent cohabitation situation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-5.579\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of social activity participation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.481\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-5.631\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC-type personality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-4.213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSedentary time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-7.425\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidity of chronic diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.253\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-5.419\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e**\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Descriptive Analysis and Correlations of Social frailty, physical resilience, aging anxiety, and fall alertness\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e lists the descriptive statistics and correlations of the examined variables. The average score of physical resilience in elderly patients with MCR (40.35\u0026thinsp;\u0026plusmn;\u0026thinsp;9.17) is below average; the average score of social frailty is 2.72\u0026thinsp;\u0026plusmn;\u0026thinsp;2.60, and the average scores of aging anxiety and fall alertness are 58.24\u0026thinsp;\u0026plusmn;\u0026thinsp;11.98 and 51.83\u0026thinsp;\u0026plusmn;\u0026thinsp;14.98, respectively. The results of the correlation analysis were consistent with our expected hypothesis,and all analysis results were statistically significant at the \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01(two-tailed) level. Firstly, Social frailty was significantly negatively correlated with physical resilience (r = -0.398), aging anxiety (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.351), and fall alertness (\u003cem\u003er\u003c/em\u003e = -0.343). Secondly, physical resilience was negatively correlated with aging anxiety (r = -0.597) and fall alertness (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.557). Aging anxiety was negatively correlated with fall alertness (\u003cem\u003er\u003c/em\u003e=-0.611).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean, standard deviation and correlation analysis of Social frailty urinary incontinence, physical resiliencesubjective well-being, aging anxietysocial participation, and fall alertnesssleep quality\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ephysical resilience\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSocial frailty\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eaging anxiety\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003efall vigilance\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ephysical resilience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e40.35\u0026thinsp;\u0026plusmn;\u0026thinsp;9.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial frailty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.72\u0026thinsp;\u0026plusmn;\u0026thinsp;2.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.398**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eaging anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e58.24\u0026thinsp;\u0026plusmn;\u0026thinsp;11.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.597**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.351**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efall vigilance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e51.83\u0026thinsp;\u0026plusmn;\u0026thinsp;14.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.557**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.343**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.611**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eAll values in the table represent Spearman's rank correlation coefficients (r); **\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01 (two-tailed)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Mediating analysis of aging anxiety and fall alertness\u003c/h2\u003e \u003cp\u003eTwelve factors with characteristic roots greater than 1 were obtained by using Harman\u0026rsquo;s single-factor analysis method. The variation explained by the first factor was 35.33%, indicating that there was no serious common method bias in this study. We used the bootstrap method to explore the role of aging anxiety and fall alertness in the relationship between Social frailty and physical resilience in the respondent group. The age, educational attainment, current cohabitation situation, frequency of social activity participation,C-type personality, sedentary time, sleep quality, and coexistence of chronic diseases of the respondents were controlled (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The results showed that Social frailty was positively correlated with aging anxiety (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.278, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and negatively correlated with fall alertness (\u003cem\u003eβ\u003c/em\u003e = -0.132, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Aging anxiety was negatively correlated with fall alertness (\u003cem\u003eβ\u003c/em\u003e=-0.491, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). We found that, after considering all other variables, aging anxiety (β = -0.291, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and fall alertness (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.196, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) were significant predictors of physical resilience. When the regression analysis included aging anxiety and fall alertness, the relationship between Social frailty and physical resilience remained significant (\u003cem\u003eβ\u003c/em\u003e = -0.149, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSequential multiple mediating models between aging anxietyurinary incontinence and physical resiliencesubjective well-being in older adults\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePredictors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eaging anxiety\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003efall alertness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003ephysical resilience\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.598\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.224**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-1.821\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-2.041*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-0.262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e-3.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e-6.194**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational attainment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-1.935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-3.186**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.842\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.933\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e2.51*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent cohabitation situation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.651\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.068**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.534\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-1.445\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-0.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e-0.702\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e-3.488**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of social activity participation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.182**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.748\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-1.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-0.213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e-1.742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e-4.306**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC-type personality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.632\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.829\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e-1.854\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e-4.002**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSedentary time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.914\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e2.559*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e3.531\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e7.569**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSleep quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.391\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.942**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-2.090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-3.817\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-0.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e-1.494\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e-4.961**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidity of chronic diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.911**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.758\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-1.911\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e-0.488\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e-2.252*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial frailty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.281\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.738**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-4.437**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-0.149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e-0.526\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e-5.569**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eaging anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.491\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.614\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e-15.489**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-0.291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e-0.223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e-9.026**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efall alertness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e6.178**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.268\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.419\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.541\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e56.810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e84.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003cem\u003eβ\u003c/em\u003e standardized coefficients, \u003cem\u003eB\u003c/em\u003e unstandardized coefficients\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e*\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e**\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe sequential mediating analysis results for the relationship between aging anxiety, fall alertness, social frailty, and physical resilience are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. The overall impact of Social frailty on physical resilience was significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), indicating that the level of fall alertness in elderly patients with MCR decreased significantly when Social frailty was severe. Furthermore, all three indirect and direct paths are also important. Specifically, the first direct pathway is that aging anxiety significantly mediates the impact of Social frailty on physical resilience, with an effect size of -0.285; The second direct approach is that fall alertness significantly mediates the impact of Social frailty on physical resilience, with an effect size of -0.091. The third indirect approach is that the impact of Social frailty on physical resilience is significantly mediated through aging anxiety and fall alertness, with an effect size of -0.094. Furthermore, aging anxiety has a significant direct impact on fall alertness, with an effect size of -0.614. These results suggest that aging anxiety and fall alertness partially mediate the relationship between Social frailty and physical resilience.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHypothesized serial mediation model of social participationaging anxiety and sleep qualityphysical resilience between urinary incontinenceSocial frailty andphysical resilience subjective well-being\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePathway\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEffect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBootLLCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBootULCI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal effect (C)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.996\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.798\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect effect (C\u0026rsquo;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.526\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.711\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ea1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.281\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.993\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.568\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ea2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.423\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ea3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.614\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.692\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.536\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eb1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.271\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.174\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eb2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.158\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndirect effects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal indirect effects (CD\u0026rsquo;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.471\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.574\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.371\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndirect 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.285\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.371\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.206\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndirect 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.047\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndirect 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAbbreviation: Indirect 1, Social frailty\u0026rarr;aging anxiety\u0026rarr;physical resilience; Indirect 2, Social frailty\u0026rarr;fall alertness\u0026rarr;physical resilience; Indirect 3, Social frailty\u0026rarr;aging anxiety\u0026rarr;fall alertness\u0026rarr;physical resilience. BootLLCI Bootstrapping lower limit confidence interval, BootULCI Bootstrapping upper limit confidence interval, SE Standard error, Effect Standardized regression coefficient\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThis study explored the impact of social frailty on the physical resilience of elderly patients with MCR, using aging anxiety and fall alertness as mediating variables for analysis. The research results show that social frailty not only directly and negatively affects physical resilience, but also has an indirect impact through two independent mediating pathways and the linked mediating pathways of aging anxiety and fall alertness.These findings provide a crucial theoretical basis for enhancing social frailty in elderly patients with MCR, and have significant practical implications for improving the physical, psychological, and social resources of patients, promoting physical resilience, and achieving successful aging.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.1 The direct impact of social decline on physical resilience\u003c/h2\u003e \u003cp\u003eDescriptive analysis revealed that the total social frailty score of elderly patients with MCR was 2.719\u0026thinsp;\u0026plusmn;\u0026thinsp;2.602, which was higher than that reported in relevant studies by Zare et al. \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e. The reason for the relatively high score may be related to the fact that elderly patients with MCR have a reduced frequency of social activity participation due to declines in physical function and bradykinesia. At the same time, symptoms such as memory decline and slow response lead to a reduction in patients' social roles and self-worth in social activities, generating a sense of stigma, which in turn triggers negative emotions such as embarrassment, anxiety, and low self-esteem, causing them to actively avoid social activities \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Therefore, the core symptoms of MCR highly overlap with the contributing factors of social frailty and exacerbate each other. In addition, the total score for physical resilience was only 40.354\u0026thinsp;\u0026plusmn;\u0026thinsp;9.173, which was lower than that reported in relevant studies \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. The low score may be related to the decline in physiological functions of elderly patients with MCR, the gradual decrease in their overall recovery ability against stressors, and the decline in physical resilience. In addition, due to the patient's memory decline, their self-management compliance is poor, which leads to an accelerated decline in physiological reserve and further aggravates the wear and tear on physical resilience. Elderly patients with MCR are often accompanied by emotions such as anxiety and depression. Negative emotions not only accelerate the depletion of physiological reserves but also deprive elderly patients with MCR of their motivation and willpower, ultimately leading to a decline in physical resilience.\u003c/p\u003e \u003cp\u003eThis study found that social frailty has a significant direct negative impact on the physical resilience of elderly patients with MCR, with a direct effect value of -0.526, accounting for 52.811% of the total effect. Elderly patients with MCR often undergo a complex transformation process from a relatively healthy state to a coexistence of frailty and cognitive decline. This stage of health transition is characterized by a decline in multiple system functions and a reduction in physiological reserves, often accompanied by a significant weakening of the body's resilience. Against the backdrop of an aging population and the coexistence of multiple diseases, social frailty, as a cumulative state of resource scarcity, constitutes a persistent source of physical and psychological stress. If there is a lack of effective social support and health service resources, such multiple stress factors will significantly increase the risk of adverse health outcomes for elderly patients with MCR, thereby directly hindering the maintenance and improvement of their physical resilience. According to the multidimensional successful aging model of bio-psycho-society \u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e, individuals, through active psychological and behavioral adaptation, mobilize internal and external resources to achieve a dynamic balance of the functions across the three dimensions. Social frailty consumes the physiological resources (neuromuscular function, metabolic reserves), psychological resources (stress adaptability), and social resources (emotional and material support) of elderly patients with MCR. Under the multi-dimensional interaction, it directly leads to a decline in mobility and an increase in fatigue, thereby significantly weakening their physical resilience. Existing research also indirectly suggests that social frailty may intensify the frailty-cognitive impairment vicious cycle in MCR syndrome, weaken the intrinsic motivation of patients to participate in rehabilitation training and maintain physical functions, and thereby damage their overall physiological recovery potential \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Therefore, the results of this study indicate that personalized intervention measures aimed at delaying or improving social frailty in elderly patients with MCR can serve as an effective approach to enhance their physical resilience and promote successful aging outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.2 The mediating role of aging anxiety\u003c/h2\u003e \u003cp\u003eThe analysis further determined the mediating role of aging anxiety in the relationship between social frailty and physical resilience in elderly patients with MCR. The mediating effect value was \u0026minus;\u0026thinsp;0.285, accounting for 28.614% of the total effect. From the perspective of the multi-dimensional successful aging model of biological-psychological-society, aging anxiety, as the comprehensive concern of elderly patients with MCR regarding the decline of physical and mental functions and the transformation of social roles during the aging process \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e, further reflects the dynamic interaction state among biological aging, psychological adjustment, and social adaptation. Moreover, the enhanced inflammatory response, suppressed immune function, and neuroendocrine disorders caused by anxiety and depression can lead to the accelerated consumption of physiological reserves, which is an important psychosocial mechanism affecting the recovery and maintenance of physical functions. Aging anxiety makes it difficult for elderly patients with MCR to effectively integrate resources and adjust behaviors, constituting an important internal obstacle to enhancing physical resilience. Future intervention can start from multiple aspects, such as reducing maladaptive anxiety, enhancing physiological and psychological coordination ability, and rebuilding social support networks, to alleviate the negative impact of aging anxiety, and thereby promote the physical function recovery and overall healthy development of elderly patients with MCR.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e4.3 The mediating role of fall alertness\u003c/h2\u003e \u003cp\u003eThe research found that fall alertness has a significant mediating effect between social frailty and physical resilience in elderly patients with MCR, with a mediating effect value of -0.091, accounting for 9.137% of the total indirect effect. This finding is consistent with the conclusions of previous studies on falls in the elderly \u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e. Individuals with a high level of fall alertness usually take proactive preventive actions (such as balance training, environmental improvement, and seeking professional support) to reduce their own fall risk, thereby maintaining or improving physical function \u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e. Based on the multidimensional successful aging model of bio-psycho-society, a higher level of fall alertness enables individuals to integrate their own abilities and external support during the aging process, maintain social activities, and effectively enhance their physical resilience. Future interventions should be based on a multidimensional model of successful aging that encompasses biological, psychological, and social aspects. Through integrated strategies, such as cognitive-behavioral guidance, environmental adaptation, and social support reinforcement, a positive and scientifically informed alertness pattern can be developed, promoting physical recovery and overall functional maintenance in elderly patients with MCR.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4.4 The multiple mediating effect between aging anxiety and fall alertness\u003c/h2\u003e \u003cp\u003eThe results of this study reveal the multiple mediating effect of aging anxiety and fall alertness in elderly patients with MCR between social frailty and physical resilience, with a mediating effect value of -0.094. Relevant studies have shown that aging anxiety and fall alertness are important factors affecting the physical and mental health and functional recovery of the elderly \u003csup\u003e[\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e. According to the successful aging model, the realization of successful aging depends on an individual's ability to maintain balance and integration among multi-dimensional resources. Individuals with high levels of aging anxiety, in the context of insufficient social resources, are prone to worry about functional decline, which in turn intensifies their perception and alertness to the risk of falls. This prompts elderly patients with MCR to actively adjust to preserve and acquire new resources (such as enhancing balance training and seeking social support). Thus, it promotes the accumulation and development of physical resilience in multiple dimensions, including biological, psychological, and social. This dynamic process reshapes the physical and mental challenges faced by elderly patients with MCR in a state of social frailty, potentially enhancing their physical resilience through behavioral adjustments. This suggests that in the intervention of elderly patients with MCR, the negative impact of social frailty on physical function can be mitigated by systematically assessing and managing the level of aging anxiety and providing a reasonable understanding of the risk of falls, thereby enhancing their physical resilience. Future research can develop or integrate comprehensive physical resilience assessment tools for the elderly that simultaneously evaluate social frailty, aging anxiety, and fall alertness, enabling early risk stratification and targeted preventive intervention measures. The emphasis is on building an intervention team composed of geriatricians, rehabilitation therapists, psychotherapists, and social workers, and designing a multidimensional, integrated intervention plan that spans social psychology to physiological functions \u003csup\u003e[\u003cspan additionalcitationids=\"CR41 CR42 CR43 CR44 CR45\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/sup\u003e. By regulating social frailty, aging anxiety, and fall alertness in elderly patients with MCR, their physiological and psychological reserves are enhanced, breaking the frailty cycle and improving physical resilience. At the same time, it is necessary to enhance interdisciplinary cooperation, promote the transformation of intervention programs from clinical practice to community-based practice, and provide replicable and scalable systematic solutions for achieving \"successful aging\".\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Limitations​","content":"\u003cp\u003eThis study employed a cross-sectional design and was unable to establish a causal relationship among the variables. Future research can adopt a longitudinal study design to more rigorously examine the causal paths and dynamic interactions among the variables. The samples were derived solely from hospitals and failed to encompass elderly patients with MCR in various care settings, including communities and elderly care institutions, which limited the generalizability of the research conclusions. Future studies can incorporate diverse elderly subgroups (such as those with different living arrangements and cultural backgrounds) for multi-center and large-sample surveys to enhance the universality of the results. All the data in this study were collected using the patient Self-rating Scale, and there is a potential for information bias. Future research should adopt a mixed-methods approach, integrating subjective scales, objective evaluations, and qualitative interviews to enhance the accuracy of self-reported data.\u003c/p\u003e"},{"header":"​6. Conclusion","content":" \u003cp\u003eThis study, through a survey of 800 elderly patients with MCR, verified the independent and chain mediating roles of aging anxiety and fall alertness in the relationship between social frailty and physical resilience, and found that social frailty was significantly negatively correlated with physical resilience. The research results show that aging anxiety and fall alertness are important mediating variables affecting social frailty in elderly patients with MCR. Clinical workers and rehabilitation intervention designers need to systematically pay attention to the accompanying aging anxiety and fall risk perception when dealing with the social frailty problem of elderly patients with MCR. And through multi-dimensional intervention strategies, anxiety is simultaneously alleviated, and a positive alertness and adaptation pattern is guided to be established, thereby more effectively promoting the recovery and maintenance of patients' physical functions and enhancing their overall rehabilitation level.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSFS-8\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSocial Frailty Scale 8-item\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnxiety about Aging Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSAFE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSelf-Awareness of Falls in Elderly scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePRIFOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePhysical Resilience Instrument for Older Adults\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMCR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMotoric Cognitive Risk Syndrome\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to Participate\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Review Committee of the Tangdu Hospital of Air Force Medical University(Ethics No.: K202602-11). Written informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003eConceptualization, Y.C. and L.A. (Li-jun An); Methodology, R.L. and Y.C.; Formal Analysis, R.L.and Y.C.; Investigation, R.L.,Y.C.,Y.D.,and M.L.; Writing Original Draft Preparation, R.L.,Y.C.; Writing Review \u0026amp; Editing, L.A. (Li-jun An); Supervision, L.A. (Li-jun An). All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMa L, Xing Y, Zhang L, Chen B, Zhang C, Yu P. Chinese expert consensus on health management of motoric cognitive risk syndrome in the elderly (2025). 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J Frailty Aging. 2021;10(4):337\u0026ndash;42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.14283/jfa.2021.27\u003c/span\u003e\u003cspan address=\"10.14283/jfa.2021.27\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Aged, Motor cognitive risk syndrome, Physical resilience, Social frailty, Aging, Anxiety, Fall alertness, Multiple mediation effect","lastPublishedDoi":"10.21203/rs.3.rs-8982822/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8982822/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSuccessful aging is a positive state of aging. Physical resilience, as a predictive indicator of future health and lifespan in the elderly, is a key entry point for them to achieve the goal of successful aging. Therefore, to promote successful aging among the elderly population, this study aimed to explore the sequential multiple mediating effects of aging anxiety and fall alertness between social frailty and physical resilience in elderly patients with motor cognitive risk syndrome(MCR).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA questionnaire survey was conducted among 800 elderly patients aged 65 and above with MCR from 11 Class-A grade-3 general hospitals in Shaanxi, Shanxi, Hunan, and Guangdong Provinces, China, using convenience sampling. The Anxiety about Aging Scale (AAS), the Self-Awareness of Falls in Elderly scale (SAFE), the Social Frailty Scale 8-item (SFS-8), and the Physical Resilience Instrument for Older Adults (PRIFOR) were used to measure the variables. Sequential multiple mediating analysis was conducted using the SPSS macro PROCESS 4.0 to evaluate the potential mediating roles of aging anxiety and fall alertness.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSocial frailty, aging anxiety, fall alertness, and physical resilience were significantly correlated(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Social frailty was not only directly related to the physical resilience of elderly patients with MCR(effect =-0.526;Standard error\u0026thinsp;=\u0026thinsp;0.094; 95%CI: LL=-0.711, UL=-0.34), and also through the independent mediating effect of aging anxiety (effect =-0.285; Standard error\u0026thinsp;=\u0026thinsp;0.042; 95%CI:LL=-0.371, UL=-0.206), the independent mediating effect of fall alertness (effect=-0.091;Standard error\u0026thinsp;=\u0026thinsp;0.025;95%CI:LL=-0.145,UL=-0.047), the chain mediating effect between aging anxiety and fall alertness (effect=-0.094;Standard error\u0026thinsp;=\u0026thinsp;0.019; 95%CI:LL=-0.134,UL=-0.058) was associated with physical resilience.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eStudies have shown that the aging anxiety and fall alertness of elderly patients with MCR in China can mediate the connection between social frailty and physical resiliency. This suggests that it may become a key target for future intervention measures aimed at enhancing the physical resilience of the elderly and promoting successful aging.\u003c/p\u003e\u003ch2\u003eClinical trial number:\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Social frailty and physical resilience in elderly patients with motor cognitive risk syndrome: the multiple mediation effect of aging anxiety and fall alertness","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-10 00:44:58","doi":"10.21203/rs.3.rs-8982822/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-03-03T21:06:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-03T08:18:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-03T08:14:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2026-02-27T03:03:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8277dc65-b4a7-4558-9a5d-8ae9dc8cb9b5","owner":[],"postedDate":"March 10th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-10T00:44:58+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-10 00:44:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8982822","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8982822","identity":"rs-8982822","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}