Social Participation as a Moderator in Spousal Frailty Interdependence Among Chinese Middle-Aged and Older Couples

Accumulating evidence suggests health similarities between married couples, yet few research has attempted to examine spousal dyadic dynamics of frailty, a debilitating age-related syndrome on the global agenda of public health priority. This study analyzed whether changes in frailty were interdependent between spouses and explored the moderating role of social participation in buffering the impact of a partner's frailty. We utilized nationwide data from four waves (2011-2018) of the China Health and Retirement Longitudinal Study, comprising 9,832 community-dwelling adults aged 45 and older (4,916 couples). Multivariable linear regression with generalized estimating equations (GEE) and moderation analyses were conducted to assess associations. Longitudinal results demonstrated that spouses were significantly interrelated in worsening the frailty score, with wives often more vulnerable to their partner's frailty than husbands. We observed social participation as a significant moderator in attenuating the negative effect of spousal frailty on own frailty, with the corresponding spousal frailty interdependence being less pronounced among individuals participating in more diversity, higher frequency, or specific types (particularly interacting with friends, playing board games, going to sports or social clubs) of social activities. Our finding of spousal frailty interdependence among middle-aged and older couples heightens awareness of enhancing support systems for spouses as "hidden patients" and emphasizes the transition from patient-only to couple-focused approach for optimizing health care schemes. Encouraging social participation may be a promising strategy to attenuate the burden associated with spousal frailty interdependence.