Psychosocial Factors Mediate the Relationship Between Olfactory Function and Cognitive Frailty in Older Adults: A Structural Equation Modelling

OBJECTIVE: With the trend of population ageing, cognitive frailty in older adults is an increasingly pressing public health issue. Identifying early-stage risk factors has become a key priority for researchers with the goal of preventing disability. This study aimed to test a conceptual model and elucidate the pathways leading to cognitive frailty using Structural Equation Modelling (SEM). METHODS: We conducted a cross-sectional design with data from outpatient departments within a tertiary medical centre in southern Taiwan. Participants (n = 208) were aged 65 years or older and able to communicate independently with the researchers. Demographic factors, extant health conditions, and psychosocial factors were collected. Structural Equation Modelling (SEM) was used to construct a path model. RESULTS: Olfactory function was significantly positively correlated with nutritional status and significantly negatively correlated with depressive symptoms, resilience, and cognitive frailty. Nutritional status was significantly negatively correlated with sarcopenia. Resilience was significantly positively correlated with social support but negatively correlated with sarcopenia. Sarcopenia was significantly positively correlated with cognitive frailty. Social support was significantly negatively correlated with cognitive frailty. Despite these associations, in this model, only one specific serial indirect pathway-via resilience and social support-demonstrated a statistically significant mediating effect between olfactory function and cognitive frailty. CONCLUSIONS: The findings suggest that the association between olfactory function and cognitive frailty may involve a limited, pathway-specific serial mediation through resilience and social support. Clinically, this pathway may help to inform the early identification of older adults with olfactory impairment who may benefit from targeted supportive strategies aimed at strengthening resilience and social support.