Network Analysis of Health‐Related Quality of Life by Frailty Status Among K orean Older Adults: K orea N ational H ealth and N utrition E xamination S urvey ( KNHANES ) 2019–2021

Vollständiger Abstract

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ABSTRACT Purpose Frailty in older adults is a multidimensional syndrome associated with adverse outcomes and reduced health‐related quality of life (HRQoL). However, differences in HRQoL structure by frailty status are not well understood, and this study aimed to compare HRQoL network structures between frail and non‐frail older adults and identify the most influential components in each group. Methods We analyzed data from 1311 adults aged ≥ 65 years in the 2019–2021 Korea National Health and Nutrition Examination Survey. Frailty was defined using a modified Fried phenotype, and HRQoL was measured with the Health‐Related Quality of Life Instrument with Eight Items. Regularized partial correlation networks were estimated, and centrality, accuracy, and stability were assessed. Results The Frail group was older, more often female, socioeconomically disadvantaged, and had higher comorbidity burdens than non‐frail group. In the frail group, depression–happiness was the strongest link, with working, depression, happiness, and sleep showing high centrality (strength); in non‐frail group, climbing stairs–pain was strongest, with working, depression, climbing stairs, and pain central. Across groups, HRQoL was positively associated with better self‐rated health, absence of unmet medical needs, and better oral health. Conclusion HRQoL is organized differently according to frailty status: mental–emotional domains dominate the frail network, whereas physical‐social domains dominate the non‐frail network. The consistently high centrality of Work across groups highlights perceived role participation as a key lever for improving HRQoL in older adults. These findings support frailty‐specific, network‐informed strategies—emphasizing emotional support in frail older adults and physical resilience in non‐frail older adults.