Mechanisms of Educational Attainment on Frailty in Older Adults with Colorectal Cancer: The Mediating Roles of Health Awareness, Physical Activity, and Stress Management

Aim: This study aims to clarify how educational attainment influences frailty in older adults with colorectal cancer (CRC). Methods: In this cross-sectional study, older adults with CRC completed surveys on general characteristics, educational attainment, health awareness, physical activity duration, stress management, and frailty. Spearman’s rank correlation analysis was employed to examine associations between variables. Mediation analyses were conducted using Hayes’ PROCESS Macro (Model 6), with 5000 bootstrap resamples to assess the significance of indirect effects. Results: A total of 169 older adults with CRC were evaluated. Educational attainment, health awareness, physical activity duration, stress management ability, and frailty were significantly correlated (P < 0.05). Educational attainment significantly predicted health awareness (β = 0.291, P < 0.001). Both educational attainment (β = 0.294, P < 0.001) and health awareness (β = 0.297, P < 0.001) positively predicted physical activity duration. Educational attainment (β = 0.266, P < 0.001) and physical activity duration (β = 0.316, P < 0.001) positively predicted stress management ability. Physical activity duration (β = –0.209, P = 0.010) and stress management ability (β = –0.335, P < 0.001) negatively predicted frailty. Physical activity duration and stress management mediated 25.38 and 36.92% of the effect of educational attainment on frailty. Chain mediation effects of health awareness and physical activity duration (7.31%), physical activity duration and stress management (12.69%), and all three factors (13.85%) were significant. Conclusions: Both physical activity duration and stress management independently mediate the relationship between educational attainment and frailty, while also exerting a chain mediating effect in older adults with CRC. Additionally, health awareness alone does not mediate the relationship between educational attainment, stress management skills, and frailty. However, educational attainment enhances health awareness, which in turn influences physical activity duration, affecting stress management and frailty.