Network analysis of frailty, sleep quality, and life satisfaction in older patients: a cross-sectional study stratified by chronic disease burden.
8 affiliations
- 1Health Science Center, Yangtze University, No. 1 Xueyuan Road, Jingzhou, Hubei, 434023, P.R. China.
- 2Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 600 Yishan Road, Xuhui District, Shanghai, 200233, P.R. China.
- 3Huanggang Central Hospital, No. 6 Qi'an Avenue, Huangzhou District, Huanggang, Hubei, 438000, P.R. China.
- 4Outpatient Service Center, Jingzhou First People's Hospital, No. 8 Hangkong Road, Shashi District, Jingzhou, Hubei, 434000, P.R. China.
- 5Department of Geriatric Medicine, Xilingol League Central Hospital, Inner Mongolia Autonomous Region, No. 9 Nadamu Street, Xilinhot, 026000, P.R. China.
- 6Department of Hepatobiliary Surgery, Xilingol League Central Hospital, Inner Mongolia Autonomous Region, No. 9 Nadamu Street, Xilinhot, 026000, P.R. China. [email protected].
- 7Department of Anesthesiology, Xilingol League Central Hospital, Inner Mongolia Autonomous Region, No. 9 Nadamu Street, Xilinhot, 026000, P.R. China. [email protected].
- 8Department of Geriatric Medicine, Xilingol League Central Hospital, Inner Mongolia Autonomous Region, No. 9 Nadamu Street, Xilinhot, 026000, P.R. China. [email protected].
Abstract
Background
Multimorbidity and chronic disease burden are common among older patients and are closely associated with frailty, poor sleep, and reduced subjective well-being. However, total-score-based analyses may obscure item-level interactions across health domains. This study examined the network structure of frailty, sleep quality, and life satisfaction in older patients and explored whether association patterns varied across chronic disease burden levels.Methods
This cross-sectional study included 1,107 older patients. Multimorbidity was defined as the presence of two or more chronic diseases. Frailty, sleep quality, and life satisfaction were assessed using the Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight (FRAIL) scale, Pittsburgh Sleep Quality Index (PSQI), and Satisfaction With Life Scale (SWLS), respectively. A regularized partial correlation network was estimated using the graphical least absolute shrinkage and selection operator (LASSO) with extended Bayesian information criterion (EBIC) model selection (EBICglasso), with scale items or components as nodes. Strength, expected influence, and bridge centrality were calculated. Stratified analyses were conducted by number of chronic diseases, and bootstrap procedures were used to assess network accuracy and stability.Results
Multimorbidity was present in 1,078 participants (97.4%), and the median number of chronic diseases was 5 (IQR, 3-6). Network analysis showed that SWLS-related nodes had relatively high strength and bridge strength, indicating relatively high statistical connectivity within the overall network and across communities. Sleep-related nodes, particularly sleep latency, use of sleeping medication, and daytime dysfunction, were prominent in signed centrality indices. Frailty nodes were mainly connected to SWLS nodes through negative edges. The SWLS community showed dense internal connections, whereas frailty and sleep quality were linked to life satisfaction primarily through negative cross-community edges. In descriptive stratified analyses, negative cross-community connections appeared more pronounced in the group with ≥ 5 chronic diseases. Because the cutoff was data-driven and no formal network comparison test was performed, the apparent between-group differences should be interpreted as descriptive and exploratory rather than statistically confirmed. Network stability analyses indicated acceptable stability.Conclusions
Among older patients, life satisfaction-related nodes showed relatively high overall connectivity, while several sleep-related nodes showed notable statistical associations within the estimated network. Given the high prevalence of multimorbidity in this sample, multidisciplinary assessment and health management should consider the interrelations among sleep problems, frailty, and life satisfaction in the context of chronic disease burden. Network analysis may provide exploratory evidence on cross-domain associations in complex health problems among older patients, but apparent differences across chronic disease burden groups require confirmation using formal network comparison tests and longitudinal designs.
Related
- Multidimensional oral health and frailty in older adults: A sex-stratified cross-sectional study
- Construction and validation of an identification model for frailty in maintenance hemodialysis patients using multiple machine learning algorithms: a cross-sectional study of retrospectively collected data
- Serum Myonectin Levels Are Positively Associated With Physical Function and Lower Frailty‐Related Limitation in Maintenance Hemodialysis Patients: A Cross‐Sectional Study
- Associations between physical activity expectations, health literacy, and life satisfaction in cancer patients: results of a quantitative cross-sectional study.
- The impact of frailty syndrome on illness acceptance and treatment adherence in older patients with rheumatoid arthritis: a cross-sectional study
BibTeX
@article{wang2026network,
title = {{Network analysis of frailty, sleep quality, and life satisfaction in older patients: a cross-sectional study stratified by chronic disease burden.}},
author = {Zhiqiang Wang and Zhanhua Wei and Xiaoya Li and Mengqiu Hu and Kaiqin Deng and Tong Cheng and Limeng Zhao and Xu Han and Zhiru Liang and Jing Wang and Shuping Zhao},
journal = {BMC geriatrics},
year = {2026},
month = aug,
doi = {10.1186/s12877-026-07958-x},
url = {https://europepmc.org/article/MED/42958059},
note = {CC BY},
}
RIS
TY - JOUR
TI - Network analysis of frailty, sleep quality, and life satisfaction in older patients: a cross-sectional study stratified by chronic disease burden.
AU - Zhiqiang Wang
AU - Zhanhua Wei
AU - Xiaoya Li
AU - Mengqiu Hu
AU - Kaiqin Deng
AU - Tong Cheng
AU - Limeng Zhao
AU - Xu Han
AU - Zhiru Liang
AU - Jing Wang
AU - Shuping Zhao
PY - 2026
DA - 2026/08/03
JO - BMC geriatrics
DO - 10.1186/s12877-026-07958-x
UR - https://europepmc.org/article/MED/42958059
AB - Background Multimorbidity and chronic disease burden are common among older patients and are closely associated with frailty, poor sleep, and reduced subjective well-being. However, total-score-based analyses may obscure item-level interactions across health domains. This study examined the network structure of frailty, sleep quality, and life satisfaction in older patients and explored whether association patterns varied across chronic disease burden levels.Methods This cross-sectional study included 1,107 older patients. Multimorbidity was defined as the presence of two or more chronic diseases. Frailty, sleep quality, and life satisfaction were assessed using the Fatigue, Resistance, Ambulation, Illnesses, and Loss of Weight (FRAIL) scale, Pittsburgh Sleep Quality Index (PSQI), and Satisfaction With Life Scale (SWLS), respectively. A regularized partial correlation network was estimated using the graphical least absolute shrinkage and selection operator (LASSO) with extended Bayesian information criterion (EBIC) model selection (EBICglasso), with scale items or components as nodes. Strength, expected influence, and bridge centrality were calculated. Stratified analyses were conducted by number of chronic diseases, and bootstrap procedures were used to assess network accuracy and stability.Results Multimorbidity was present in 1,078 participants (97.4%), and the median number of chronic diseases was 5 (IQR, 3-6). Network analysis showed that SWLS-related nodes had relatively high strength and bridge strength, indicating relatively high statistical connectivity within the overall network and across communities. Sleep-related nodes, particularly sleep latency, use of sleeping medication, and daytime dysfunction, were prominent in signed centrality indices. Frailty nodes were mainly connected to SWLS nodes through negative edges. The SWLS community showed dense internal connections, whereas frailty and sleep quality were linked to life satisfaction primarily through negative cross-community edges. In descriptive stratified analyses, negative cross-community connections appeared more pronounced in the group with ≥ 5 chronic diseases. Because the cutoff was data-driven and no formal network comparison test was performed, the apparent between-group differences should be interpreted as descriptive and exploratory rather than statistically confirmed. Network stability analyses indicated acceptable stability.Conclusions Among older patients, life satisfaction-related nodes showed relatively high overall connectivity, while several sleep-related nodes showed notable statistical associations within the estimated network. Given the high prevalence of multimorbidity in this sample, multidisciplinary assessment and health management should consider the interrelations among sleep problems, frailty, and life satisfaction in the context of chronic disease burden. Network analysis may provide exploratory evidence on cross-domain associations in complex health problems among older patients, but apparent differences across chronic disease burden groups require confirmation using formal network comparison tests and longitudinal designs.
SN - 1471-2318
ER -