Perceived Control, Chronic Stress, and Geriatric Frailty: Explicating Frailty's Psychosocial Etiology

Frailty in older adults is a highly prevalent syndrome that is characterized by increased vulnerability to stressors and is more generally thought to result from dysregulation across multiple physiologic systems. Although research has long recognized that psychosocial factors including chronic stress and perceived control influence geriatric health outcomes, relatively little research has explored their etiologic role in the development of frailty. Thus, the primary purpose of this study was to close key knowledge and methodological gaps that exist within the extant literature and to develop empirically based insights into the psychosocial etiology of geriatric or phenotypic frailty, using the allostatic load model of stress and a model of perceived control as guiding theoretical frameworks. Using a population-based sample of older adults from the Health and Retirement Study, the present study found a frailty prevalence of 7-8% in study subsamples. In structural equations modeling, the present study found that perceived control fully mediated the chronic stress and baseline phenotypic frailty and change in phenotypic frailty relationship, as well partially mediated the relationship linking socioeconomic status and baseline phenotypic frailty and change in phenotypic frailty. Multiple group analyses supported hypotheses that the mediating role of control was equivalent across gender and racial subgroups. Contrary to hypotheses, the present study found no evidence to support a stress-buffering or moderating effect of perceived control on baseline or change in phenotypic frailty status. Findings from the study advance the understanding of frailty's psychosocial etiology and underscore the importance of psychosocial factors in senescence and older adult health more generally.