Archives of Gerontology and Geriatrics 113 (2023) 105019

Contents lists available at ScienceDirect

Archives of Gerontology and Geriatrics

journal homepage: www.elsevier.com/locate/archger

Association of nutrition management status, frailty, and social contact

frequency with life satisfaction in older adults: A moderated
mediation model
Jeongok Park a, Ahyoung Cho b, c, Sejeong Lee d, Hyojin Lee d, *
a
Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea
b
Yonsei University College of Nursing, Seoul, South Korea
c
Education of Counseling, Konkuk University, Seoul, South Korea
d
College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea

A R T I C L E I N F O A B S T R A C T

Keywords: Objectives: As the trend of aging has become global phenomenon, identifying the pathways to life satisfaction for
Frailty older adults is important for maintaining their quality of life. This study aimed to investigate the relationship of
Life satisfaction nutrition management status, frailty, and life satisfaction, and the moderated mediating effect of social contact
Nutrition management status
frequency to this relationship, to older adults in South Korea.
Quality of life
Social contact frequency
Methods: In this secondary data analysis using the dataset of the 2020 National Survey of Older Koreans, the data
from 6,663 of the original 10,097 participating older adults who were 65 years or older were included. The
independent t-test; chi-square test; and mediating, moderating, and moderated mediating effect analyses were
performed.
Results: The results confirm a mediating effect of frailty on the relationship between nutrition management status
and life satisfaction in older adults. Social contact frequency had a moderating effect on the relationship between
frailty and life satisfaction. Finally, a moderated mediating effect of social contact frequency on the mediating
effect of frailty was identified.
Discussion: This study is the first to identify a specific path to the life satisfaction of older adults in South Korea
using large-scale research. In addition, this study provided the basis for preparing basic data necessary to support
older adults’ life satisfaction in a global aging society. This study is expected to help prepare the necessary
intervention measures to improve older adults’ quality of life and life satisfaction.

1. Introduction accounted for approximately 14.9% of the total population in 2019, is

The overall population of older adults is increasing worldwide
(Kulik et al., 2014), as well as in South Korea (Ko & Jung, 2021). Ac­
cording to Kulik et al. (2014), this increase in the global older adult
population is characterized by two trends: a dramatic increase in life
expectancy and a decrease in fertility rates. In South Korea, the life
expectancy in 1998 was 75.8 years old, which increased by about 7.7
years to 83.5 years in 2020 (Bahk & Jung-Choi, 2020; Korea National
Statistical Office, 2021). South Korea was one of the countries with the
longest life expectancy among the 35 industrialized countries surveyed
in 2017 (Kontis et al., 2017). Moreover, the fertility rate was only 0.84 in
South Korea as of 2020 (Korea National Statistical Office, 2021).
Accordingly, the proportion of older adults in South Korea, which
expected to reach 46.5% by 2067 (Korea Institute for Health and Social
Affairs, 2020).
This phenomenon is not unique to South Korea. In 2010, the number
of older adults who were 65 years and above in the United Kingdom was
about 10 million, but by 2050, the number is expected to reach
approximately 19 million, which constitutes about a quarter of the total
population (Cracknell, 2010). In the case of the United States, the pro­
portion of older adults of age 65 years and above, which accounted for
about 14.5% of the total population in 2017, is expected to double by
2060 (National Institute of Health, 2018).
With the explosive population of older adults, a trend that values
quality of life of older adults is now being formed beyond simply living
physically healthy for a long time. While previous research on older

* Corresponding author: College of Nursing and Brain Korea 21 FOUR Project, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea.
E-mail address: 921hlee@gmail.com (H. Lee).

https://doi.org/10.1016/j.archger.2023.105019
Received 17 January 2023; Received in revised form 26 March 2023; Accepted 3 April 2023
Available online 11 April 2023
0167-4943/© 2023 Elsevier B.V. All rights reserved.
J. Park et al.
adults, before the rise in population aging, mainly focused on the health
and lifespan of older adults, recent research has given more importance
to improving older adults’ quality of life in addition to the physical and
mental health of older adults (Tada, 2018). This focus is consistent with
recent studies by Mao and Han (2018) and Zhang et al. (2017), who
studied various factors that have an important influence on the quality
of life of older adults.
Among the various variables related to the quality of life of older
adults, it has been found that subjective life satisfaction (Ma et al.,
2018), nutrition management status (Chang, 2017; Hsieh et al., 2019),
frailty (Wilhelmson et al., 2013; Kojima et al., 2016; Palomo- Vélez
et al., 2020), and social relationships in older adults (Liu et al., 2021;
Rafnsson et al., 2015; Sharif et al., 2021) had an important effect.
Among the variables, nutrition and nutrition-management status are
shown to be directly related to frailty (Jayanama et al., 2018) and life
satisfaction (Ghimire et al., 2018). Frailty is widely known to decrease
life satisfaction. For this reason, previous researchers have suggested
that preventing or delaying the development of frailty is a way to
maintain life satisfaction in older adults (Wilhelmson et al., 2013). In
addition, social support and social relationships have been shown to
moderate the relationship between health status and life satisfaction
among older adults (Dumitrache et al., 2017). Mao et al. (2021), how­
ever, emphasized the dearth of empirical research on the path between
various variables, including family and social context, on the life satis­
faction of older adults. In other words, although previous studies have
identified the relationship between each of multiple variables related to
older adults’ life satisfaction and quality of life (Giebel et al., 2020; Mao
et al., 2021), few studies have been conducted to find a specific pathway
to the life satisfaction of older adults in South Korea by integrating each
variable. In addition, the concept that represents social relationships is
diverse among studies including social support (Liu et al., 2021) and
attachment (Shariff et al., 2021). However, social contact frequency,
which is reported to be closely related to life satisfaction of older adults
(Rafnsson et al., 2015), was not investigated along with nutrition
management status and frailty. Therefore, to provide preliminary data
for improving the quality of life of older adults, this study tried to
determine the relationship between life satisfaction, nutrition manage­
ment status, frailty, and social contact frequency in older adults.
It is especially important to identify the level of life satisfaction of
older adults who do not live with their children. In South Korea, most
older parents used to live with their eldest son or other children. This
tradition can be seen as the influence of a Confucian culture that has
been around for a long time. In recent years, however, this trend has
weakened considerably. According to the 2017 National Survey of Older
Koreans, 19.8% of older adults 65 years or older were living alone, and
58.4% of older adults were living together only with their spouses.
Around this period, only 20.1% of older adults were found to be living
with their children (Korea Institute for Health and Social Affairs, 2017),
which is significantly lower than the 2008 ratio when 28.6% of all older
adults’ households included older adults living with their children (Han,
2008). Thus, as the proportion of older adults who do not live with their
children is rapidly increasing, currently accounting for approximately
80% of the total, this study focused on households with older adults who
live without their children—either alone or with their spouses or others,
to provide basic data to improve their quality of life.
The purpose of this study was (1) to determine whether there are any
differences in general and health-related characteristics of households
with older adults who do not live with their children according to their
frailty status, and (2) to identify the relationship between nutrition
management status, frailty, life satisfaction, and social contact fre­
quency of older adults. Specifically, this study aimed to identify whether
a mediating effect of frailty on the relationship between nutrition
management status and life satisfaction in older adults, whether a
moderating effect of social contact frequency on the relationship be­
tween frailty and life satisfaction exists, and finally, in the relationship
between nutrition management status and life satisfaction, whether a
2
Archives of Gerontology and Geriatrics 113 (2023) 105019
moderated mediating effect of social contact frequency with the medi­
ating effect of frailty exists.
2. Materials and methods
2.1. Design and participants
This study was a secondary data analysis using the dataset of the
2020 National Survey of Older Koreans (Korea Institute for Health and
Social Affairs, 2020). This survey was conducted by the Korean Ministry
of Health and Welfare—from September through November 2020—with
the aim of ensuring the basic data necessary for establishing policies for
older adults in Korea. Using stratified sampling based on the proportion
of the population by region on South Korea, the original data were
collected via face-to-face interviews during household visits. If the
participants had any difficulty responding by themselves for reasons
such as illness, other family members or caregivers sometimes respon­
ded to some questions.
A total of 10,097 older adults participated in the 2020 National
Survey of Older Koreans. Among them, 177 older adults who did not
respond by themselves were excluded. Additionally, 3257 older adults
were excluded based on the following exclusion criteria: (1) those who
did not respond to any of the six life satisfaction questions; (2) those who
did not have children or currently lived with their children; and (3)
those who had no grandchildren, siblings or relatives, and friends or
neighbors to contact. Finally, 6663 older adults were included in the
analysis.
This study was approved by the Review Board of Y University (Y-
2020-0205).
2.2. Measures
2.2.1. Life satisfaction
This study assessed older adults’ life satisfaction using six questions,
which measured the degree of life satisfaction in six areas—health sta­
tus, economic status, relationship with their children, relationship with
friends and communities, leisure activities, and daily life. Life satisfac­
tion was measured using seven questions in the original survey (National
Survey of Older Koreans, 2020). However, since 37.0% of the partici­
pants did not live with their spouse, the question on life satisfaction of
the relationship with their spouse was excluded from the assessment.
Each question was reversely scored using a 5-point Likert scale (1 = very
satisfied, 2 = satisfied, 3 = normal, 4 = not satisfied, 5 = not satisfied at
all). The possible scores ranged from 6 to 30, with a higher score indi­
cating a higher level of life satisfaction. The reliability of the measure­
ment was α=0.85 in the current study.
2.2.2. Nutrition management status
Nine questions from 2020 National Survey of Older Koreans were
used to measure the nutritional management status of older adults
(National Survey of Older Koreans, 2020). Each question measured the
nutritional management status in various areas—changing the amount
and type of food because of illness or health status, eating less than two
meals a day, not eating fruits/vegetables/dairy products, drinking more
than three glasses of alcohol almost every day, difficulty in eating
because of their oral condition, difficulty in buying food because of the
financial situation, and eating alone nearly every time. The participants
scored 0 points if they answered “Yes” to the questions and 1 point if not.
The possible scores ranged from 0 to 9, with a higher score indicating
better nutritional management status.
2.2.3. Frailty
The assessment of frailty in older adults was based on a phenotype
model by Fried et al. (2001). According to Pilotto et al. (2020), frailty
can be diagnosed if it involves three or more of the following five as­
pects: unintended weight loss, exhaustion, low physical activity, slow
J. Park et al. Archives of Gerontology and Geriatrics 113 (2023) 105019

pace, and muscle strength loss. In this study, frailty was measured using Table 1
the following items: (1) has lost or gained more than 5 kg in the past six Demographic characteristics of participants and differences in general factors by
months (Kim & Chung, 2019), (2) has lost a lot of activity or motivation frailty (n = 6663).
these days (Pilotto et al., 2020), (3) can walk around the playground for Characteristics Total Frailty n = Non-/pre- t/x2(p)
about 400 m (Fried et al., 2001), (4) can climb 10 steps without a break 735 frailty
(Kim & Chung, 2019), and (5) can sit on a chair or bed and repeat five (11.0%) n = 5928
(89.0%)
times (Kim & Chung, 2019). If the participants report “yes” for items (1)
and (2), they receive a score of 1 point; if not, 0 points. On the contrary, Sex 62.191
Male 2692 198 (26.9) 2494 (<0.001)
if they report “yes” for items (3), (4), and (5), they receive 0 points; if
Female (40.4) 537 (73.1) (42.1)
not, 1 point. Frailty score 0 (zero) refers to non-frailty, 1–2 to pre-frailty, 3971 3434
and 3 and above to frailty. The current study has incorporated (59.6) (57.9)
non-frailty and pre-frailty, and divided frailty into two categories: Age 72.74 77.27 ± 72.18 ± 514.252
non-/pre-frailty and frailty. ± 5.968 6.342 5.673 (<0.001)
Living with a spouse 151.503
Yes 4197 311 (42.3) 3886 (<0.001)
2.2.4. Social contact frequency No (bereaved, (63.0) 424 (57.7) (65.6)
We used four questions to measure the level of social contact fre­ divorced, unmarried) 2466 2042
quency among older adults (National Survey of Older Koreans, 2020). (37.0) (34.4)
Education level 232.901
Each question refers to the frequency of social communication with
Under elementary 2741 486 (66.1) 2255 (<0.001)
older adults in four areas (with their children, grandchildren, relatives graduates (41.1) 147 (20.0) (38.0)
including siblings, friends/neighbors/acquaintances) over the past year. Middle school 1639 82 (11.2) 1492
Each question was reverse-scored on a 7-point Likert scale (0: Almost graduates (24.6) 20 (2.7) (25.2)
every day, 1: 2–3 times a week, 2: once a week, 3: once or twice a month, High school graduates 1896 1814
College graduates or (28.5) (30.6)
4: once or twice a quarter year, 5: once or twice a year, 6: no contact).
higher 387 367 (6.2)
The possible scores ranged from 0 to 24 points, with a higher score in (5.8)
total indicating more frequent social contact. Economic status 63.223
Basic livelihood 244 55 (7.5) 189 (3.2) (<0.001)
recipients (3.7) 33 (4.5) 98 (1.7)
2.2.5. Demographical and health-related characteristics
Medical benefit 131 647 (88.0) 5641
Demographic and health-related characteristics included gender, recipients (2.0) (95.2)
age, marital status, education level, economic status, depression level, Others 6288
number of chronic diseases, instrumental activities of daily living (94.4)
(IADL), and cognitive function. Marital status was categorized as “living Depression level (0–15) 3.15 ± 6.42 ± 2.74 ± 975.932
3.230 3.968 2.878 (<0.001)
with a spouse” or “no spouse (bereaved, divorced, or unmarried).” Ed­
Number of chronic 1.82 ± 2.67 ± 1.72 ± 289.254
ucation level was divided into the following categories: “under diseases 1.466 1.829 1.379 (<0.001)
elementary school graduates,” “middle school graduates,” “high school (0–13)
graduates,” and “college graduates or higher.” The economic status of Instrumental activities 10.42 12.26 ± 10.19 ± 677.935
of daily living (IADL) ± 2.130 4.794 1.335 (<0.001)
the participants was assessed by the types of national medication ben­
(10–30)
efits such as “basic livelihood recipients,” “medical benefit recipients,” Cognitive function 24.85 22.00 ± 25.20 ± 276.582
and “others.” Depression level was measured using the Korean version of (MMSE-DS) (0–30) ± 5.009 5.550 4.822 (<0.001)
the Geriatric Depression Scale-15 (Bae & Cho, 2004), which was Nutrition management 10.80 9.52 ± 10.96 ± 518.194
developed to evaluate depression in older adults. Participants’ IADL status (0–9) ± 1.677 2.566 1.456 (<0.001)
Social contact 12.95 12.66 ± 12.99 ± 6.561 (p =
(Won et al., 2002) were used to measure the degree to which indepen­
frequency (0–24) ± 3.326 3.533 3.298 .010)
dence and help are needed in areas such as dressing by oneself, doing Life satisfaction (6–30) 21.19 19.41 ± 21.42 ± 214.477
housework, and preparing meals. Higher scores indicated that partici­ ± 3.548 4.196 3.396 (<0.001)
pants needed more help from others to perform daily living. Finally, the
Korean version of the Mini-Mental State Examination (MMSE-DS) was
used to determine the level of cognitive function of the participants by 3. Results
assessing their memory and concentration.
Table 1 presents the characteristics of the participants according to
2.3. Data analysis their frailty status (n = 6663). The mean age of the participants was
72.74 (SD = 5.97). Of these, 2692 (40.4%) were male and 3971 (59.6%)
SPSS ver.21.0 and Hayes’ PROCESS macro ver.4.0 were used to were female. Of the total participants, 735 (11.0%) were in the frailty
analyze the data. First, descriptive statistics for the study variables were group and 5928 (89.0%) in the non-/pre-frailty group. All participants’
computed for the frailty and non-/pre-frailty groups. The independent t- characteristics were significantly different between the frailty and non-/
test and chi-square test were performed to compare participant char­ pre-frailty groups (Table 1).
acteristics between the frailty and non-/pre-frailty groups. Then, as
Preacher et al. (2007) proposed, analyses for mediating, moderating, 3.1. Mediating effect of frailty in the relationship between nutrition
and moderated mediating effects were conducted. The PROCESS Model management status and life satisfaction
14 was used to test the moderated mediating effect to determine
whether the indirect effect of nutrition management status on life The PROCESS macro Model 4 proposed by Hayes (2013) was used to
satisfaction through frailty is conditional on social contact frequency. To verify the mediating effect of frailty on the relationship between nutri­
test the significance of indirect effects, the bootstrap method was carried tion management status and life satisfaction. The results are presented in
out with 5000 resamples to estimate (95% confidence intervals [Cl]; Table 2. Nutrition management status had a significant effect on life
Hayes, 2018; Preacher & Hayes, 2008). Cognitive function assessed with satisfaction (β = 0.3387, p < .001) in Model 1, and nutrition manage­
MMSE was included as a covariate ment status had a significant effect on frailty (β=− 0.2466, p < .001) in
Model 2. In Model 3, nutrition management status (β = 0.1342, p <
.001) and frailty (β=− 0.8292, p < .001) had significant effects on life

3
J. Park et al. Archives of Gerontology and Geriatrics 113 (2023) 105019

Table 2
Mediating effect of frailty in the relationship between nutrition management status and life satisfaction.
β SE T p LLCI* ULCI**

Model 1 (dependent variable: life satisfaction)

Nutrition management status .3387 .0341 9.9374 .0000 .2719 .4055
Model 2 (dependent variable: frailty)
Nutrition management status − 0.2466 .0103 − 23.9441 .0000 − 0.2668 − 0.2265
Model 3 (dependent variable: life satisfaction)
Nutrition management status .1342 .0344 3.9016 .0001 .0668 .2016
Frailty − 0.8292 .0392 − 21.1269 .0000 − 0.9061 − 0.7522

*LLCI: lower limit of bootstrapping within the 95% confidence interval (CI) of the indirect effect.
**ULCI: higher limit of bootstrapping within the 95% confidence interval (CI) of the indirect effect.

frequency. This result means that the effect of frailty on life satisfaction
Table 3
depends on the degree of social contact frequency. In addition, the
Moderating effect of social contact frequency in the relationship between frailty
amount of change in R2 resulting from the addition of the interaction
and life satisfaction.
variable was 0.0007 (p < .05), which was statistically significant. The
SE T p LLCI* ULCI**
β
results verify the moderating effect of social contact frequency on the
Model 1 (dependent variable: life satisfaction) relationship between frailty and life satisfaction.
Frailty − 1.1585 .1404 − 8.2508 .0000 − 1.4338 − 0.8833
Social contact .2569 .0155 16.5496 .0000 .2265 .2873
frequency
3.3. Moderated mediating effect of social contact frequency in the
Model 2 (dependent variable: life satisfaction)
Frailty X .0254 .0106 2.4036 .0163 .0047 .0462
relationship between nutrition management status, frailty, and life
social satisfaction
contact
frequency The PROCESS macro Model 14 was used to verify the moderated
Change in R2 resulted from the addition of the R2 F p
mediating effect of social contact frequency on the relationship between
interaction variable .0007 5.7774 .0163
nutrition management status, frailty, and life satisfaction. In addition to
*LLCI: lower limit of bootstrapping within the 95% confidence interval (CI) of the main variables, cognitive function was included as a covariate. The
the indirect effect. results are presented in Table 4. Nutritional management status nega­
**ULCI: higher limit of bootstrapping within the 95% confidence interval (CI) of
tively affected frailty (β=− 0.2340, p < .001) in Model 1, and frailty
the indirect effect.
negatively affected life satisfaction (β=− 1.1215, p < .001) in Model 2,
each of which was statistically significant, indicating a mediating effect
satisfaction. The direct effect of the pathway between nutrition man­ of frailty. Nutrition management status (β = 0.0801, p = .016) and social
agement status and life satisfaction decreased from 0.3387 (p < .001) in contact frequency (β = 0.2493, p < .001) positively affected life satis­
Model 1 to 0.1342 (p < .001) in Model 3, indicating the mediating effect faction. The interaction between frailty and social contact frequency had
of frailty. These results verified that frailty plays a mediating role be­ a significant effect on life satisfaction (β = 0.0271, p = .011), indicating
tween nutrition management status and life satisfaction.
Table 5
The conditional moderated mediating effect of social contact frequency.
3.2. Moderating effect of social contact frequency in the relationship
between frailty status and life satisfaction β SE t p LLCI* ULCI**

M-1SD(M- − 0.6842 .0529 − 12.9387 .0000 − 0.7879 − 0.5806

PROCESS macro Model 1 was used to verify the moderating effect of 3.3264)
social contact frequency on the relationship between frailty and life M(0.0000) − 0.6044 .0412 − 14.6651 .0000 − 0.6852 − 0.5236
M + 1SD(M − 0.5246 .0550 − 9.5367 .0000 − 0.6324 − 0.4168
satisfaction. The results of the analysis are presented in Table 3. Frailty + 3.3264)
had a significant effect on life satisfaction (β=− 1.1585, p < .001), and
social contact frequency also had a significant effect on life satisfaction *LLCI: lower limit of bootstrapping within the 95% confidence interval (CI) of
the indirect effect.
(β = 0.2569, p < .001). The interaction variable of frailty and social
**ULCI: higher limit of bootstrapping within the 95% confidence interval (CI) of
contact frequency had a significantly positive effect on life satisfaction
the indirect effect.
(β = 0.0254, p < .05), indicating the moderating effect of social contact

Table 4
Moderated mediating effect of social contact frequency.
β SE T p LLCI* ULCI**

Model 1 (dependent variable: frailty)

Nutrition management status − 0.2340 .0102 − 22.9914 .0000 − 0.2539 − 0.2140
Cognitive function (MMSE-DS) − 0.0268 .0018 − 14.6456 .0000 − 0.0304 − 0.0232
Model 2 (dependent variable: life satisfaction)
Nutrition management status .0801 .0331 2.4170 .0157 .0151 .1450
Frailty − 1.1215 .1404 − 7.9861 .0000 − 1.3968 − 0.8462
Social contact frequency .2493 .0156 16.0167 .0000 .2188 .2798
Frailty X Social contact frequency .0271 .0106 2.5598 .0105 .0063 .0478
Cognitive function (MMSE-DS) .0268 .0058 4.5922 .0000 .0153 .0382
R2 change resulted from the addition of the interaction variable R2 F p
.0008 6.5527 .0105

*LLCI: lower limit of bootstrapping within the 95% confidence interval (CI) of the indirect effect.
**ULCI: higher limit of bootstrapping within the 95% confidence interval (CI) of the indirect effect.

4
J. Park et al.
a moderating effect of social contact frequency. In addition, the change
in R2 resulting from the addition of the interaction variable was 0.0008
(p = .011), which was statistically significant. The results verified the
moderated mediating effect of social contact frequency on the pathway
of nutrition management status to life satisfaction through frailty.
Table 5 shows the conditional moderated mediating effect of social
contact frequency, using the bootstrapping method with mean and ±
1SD values of social support. The conditional effect of frailty according
to social contact frequency was significant at the levels of M-1SD
(− 3.3264), M (0.0000), and M + 1SD (3.3264). It was also discovered
that the lower the social contact frequency, the greater the indirect effect
of moderated mediation (− 1SD=− 0.6842, mean=− 0.6044,
1SD=− 0.5246). Thus, the effect of frailty on life satisfaction was sig­
nificant in areas where the social contact frequency values were M and
M ± ± 1SD. Therefore, the effects found in the relationship between
nutrition management status, frailty, and life satisfaction can be
adjusted according to social contact frequency. The mediating effect of
frailty can be especially high for those with low levels of social contact
frequency.
4. Discussion
This study examined how the pathway of nutrition management
status to life satisfaction through frailty varies depending on the level of
social contact frequency using the moderated mediation model.
The major findings of this study are as follows: First, the mediating
effect of frailty on the relationship between nutrition management status
and life satisfaction in older adults was confirmed. Second, the moder­
ating effect of social contact frequency on the relationship between
frailty and life satisfaction was also supported. Specifically, the higher
the social contact frequency, the lower the influence of frailty on life
satisfaction, and vice versa. Third, in the relationship between nutrition
management status and life satisfaction, a moderated mediating effect of
social contact frequency with the mediating effect of frailty was iden­
tified. These results imply that social contact frequency has an impact on
the influence of nutrition management status on life satisfaction through
frailty.
The finding of the mediating role of frailty confirmed from the cur­
rent study supports the association between frailty, nutritional status,
and life satisfaction found in previous studies (Wilhelmson et al., 2013;
Kojima et al., 2016; Palomo- Vélez et al., 2020; Ko & Jung, 2021). In a
study of community-dwelling older Koreans, frailty was found to have
strongest correlation with life satisfaction (Ko & Jung, 2021). Frailty
was reported to have a direct and indirect negative correlation with the
life satisfaction of older adults (Wilhelmson et al., 2013). Specifically,
older adults who are frail reported significantly lower life satisfaction
than older adults who are not frail (Palomo-Vélez et al., 2020), and
compared to non-frail older adults who had higher life satisfaction over
time, frail older adults had lower life satisfaction over time (Kojima
et al., 2016). Frailty was also related to the nutrition management status
of older adults, which means that poor nutrition management status is
related to increased frailty (Chang, 2017). In cases of malnutrition due
to inadequate food intake, the muscles of older adults are exhausted; this
condition can accelerate and increase the risk of frailty (Kim et al.,
2018). In contrast, it is known that older adults with better nutritional
dietary patterns, such as having large amounts of protein-rich and
phytonutrient-rich plant foods, had a lower risk of frailty than those who
did not (Hsieh et al., 2019). While the existing literature reported the
relationships between each variable independently, the current study
supplemented the detail to the relationships, making the explanation of
the associations more explicit.
The results from this study supported the impact of social support on
physical and psychological well-being of older adults reported in pre­
vious literature. According to existing studies, social support from
family and friends is the core of older adults’ lives (Sharif et al., 2021),
and is related to frailty (Mao & Han, 2018), psychological health
5
Archives of Gerontology and Geriatrics 113 (2023) 105019
(Tsutsumimoto et al., 2018), subjective happiness (Ma et al., 2018), and
life satisfaction (Liu et al., 2021) in older adults. Simone and Haas
(2013) also reported that low social support among older adults is a
factor that reduces their subjective happiness. Similarly, the feeling of
social withdrawal reported by older adults was found to be an important
factor that lowered the level of life satisfaction (Celik et al., 2018). Not
only the direct association of social support with life satisfaction, but
also certain roles of social contact frequency found in the current study
supported previous findings of buffering or controlling role.
Yang et al. (2016) reported that lower social isolation buffered the
impact of frailty on life satisfaction. In other words, older adults who
were less socially vulnerable tended to experience a negative impact of
frailty on life satisfaction less. Social support also played a role in con­
trolling the relationship between stress and life satisfaction of older
adults (Kang et al., 2017). Considering that social support, especially
from family members, has a greater effect on older adults’ frailty and life
satisfaction (Smith et al., 2017), the current study confirmed the
importance of frequent contact with family members in alleviating older
adults’ frailty and that such social contact can have a positive effect on
older adults’ life satisfaction.
This study confirmed the mediating role of frailty in the relationship
between nutrition management status and life satisfaction in older
adults in Korea, thereby clarifying the relationship between nutrition
management status and life satisfaction of older Koreans. These results
will improve our understanding of how older Koreans with better
nutrition management status achieve high life satisfaction. Additionally,
by confirming the moderating role of social contact frequency in the
relationship between frailty and life satisfaction of older Koreans, a
mechanism that can explain older Koreans’ life satisfaction was found.
In other words, the higher the frailty, the lower the life satisfaction of
older Koreans, with low social contact frequency operating as a
vulnerability factor in this relationship, indicating that older Koreans
with frailty are more likely to have low life satisfaction if they have low
social contact frequency. These results imply that to improve the life
satisfaction of older Koreans, social and emotional support such as
frequent social contact as well as an intervention on nutritional man­
agement status is important.
A mechanism that can improve the life satisfaction of older adults in
Korea was found by confirming the moderated mediating effect of frailty
on nutritional management status and life satisfaction depending on the
level of social contact frequency. The results indicate that the lower the
social contact frequency of older Koreans, the more likely they will be
vulnerable to the influence of frailty, and thus life satisfaction will
decrease. This also implies that even if older Koreans are exposed to
frailty due to poor nutritional management, increasing social contact
frequency can weaken the link that leads to a decrease in life satisfac­
tion. Therefore, not only direct support to help older adults in proper
nutrition management but also interventions focused on alleviating
older adults’ frailty and increasing social contact frequency will be
important to improve their life satisfaction,
To the best of our knowledge, our study is the first to identify a
specific pathway to life satisfaction among older adults in Korea based
on the data of a nation-wide scale. The large and recently surveyed
sample increased the validity of the study. The findings of the roles of
the variables also is a strength of this study in that it suggests a mech­
anism to improve life satisfaction of older adults. Lastly, this study re­
flects the ongoing transformation of Korean culture. Although the aging-
society phenomenon is occurring all around the world, it has its own
socio-cultural characteristics in Korean society; these relate to a child’s
parental obligation. In Korea, it was traditional for adult children to live
with their elderly parents. The phenomenon of older adults living alone
or with only a spouse was relatively rare. In recent years, older adults
have increasingly begun to live independently, without their children.
This study investigates the changing lives of elderly people in Korean
society and addresses their newly emerging lifestyles. In particular, it
makes a meaningful contribution by examining the importance of social-
J. Park et al.
Fig. 1. Flow diagram of the current study.
contact frequency with others, a factor that was relatively unimportant
when older adults lived with their children.
This study has a few limitations. As this study was a cross-sectional
secondary data analysis, the causality of the variables could not be
explored. Longitudinal studies are required to further clarify the cau­
sality. In addition, the social contact frequency variable used in the
current study was defined as the sum of contact frequencies of older
adults with their children, grandchildren, siblings or relatives, and
friends or neighbor, making it difficult to reflect some parts of the
quality or depth of social contact. Further studies that consider various
aspects of social contact are needed. Third, participants with cognitive
impairments were not excluded from either the source study or the
present study. Thus, the results of the present study must be interpreted
with caution. Fourth, the social-contact-frequency variable in the cur­
rent study does not distinguish between social contact with family
members and social contact with others. As these two types of social
contacts may function differently, further research is needed to distin­
guish between the two types of social contacts and to investigate how
they both work.
Regardless of the limitations stated above, the results of this study
contribute to the practice and research of healthcare providers and
Fig. 2. Mediating effect of frailty in the relationship between nutrition management status and life satisfaction.
6
Archives of Gerontology and Geriatrics 113 (2023) 105019
social workers. Nutritional-management status, frailty, social-contact
frequency, and life satisfaction are comprehensively interrelated—and
no previous study has reported on this from an integrated perspective.
To provide older adults with a better quality of life in their later years,
multidimensional aspects must be considered synthetically, through
future research with a multidisciplinary approach of nutrition, kinetics,
social welfare, psychology, and others. In particular, considering that
the physical and mental health of older adults is inseparable from the
health of social relations, interventional research is needed to improve
the social health of older adults. In addition to family and friends, it is
suggested to specify social relations that especially play roles to older
adults, for example health care providers.
5. Conclusions
In conclusion, it was found that social contact frequency has an
impact on the influence of nutrition management status on life satis­
faction through frailty in the context of older adults in South Korea. This
study provides preliminary data necessary to support older adults’
quality of life in a global aging society. It is also expected that this study
would help prepare intervention measures to improve older adults’
J. Park et al.
Fig. 3. Moderating effect of social contact frequency in the relationship between frailty and life satisfaction.
Fig. 4. Moderated mediating effect of social contact frequency.
quality of life and life satisfaction Figs. 1–4.
CRediT authorship contribution statement
Jeongok Park: Conceptualization, Methodology, Supervision, Vali­
dation. Ahyoung Cho: Methodology, Writing – original draft. Sejeong
Lee: Writing – review & editing. Hyojin Lee: Data curation, Writing –
original draft, Writing – review & editing.
Declaration of Competing Interest
The authors have no conflict of interest to declare.
Funding
This work was supported by a Basic Science Research Program
through the National Research Foundation of Korea (NRF) funded by the
Ministry of Education (grant number 2020R1A6A1A03041989); the
National Research Foundation of Korea(NRF) grant funded by the Korea
government (MSIT) (grant number 2022R1A2C1092084); and the Brain
Korea 21 FOUR Project funded by National Research Foundation (NRF)
of Korea, Yonsei University College of Nursing (grant number
7
Archives of Gerontology and Geriatrics 113 (2023) 105019
F21JB7504007)
References
Bae, J. N., & Cho, M. J. (2004). Development of the Korean version of the Geriatric
Depression Scale and its short form among elderly psychiatric patients. Journal of
Psychosomatic Research, 57(3), 297–305. https://doi.org/10.1016/j.
jpsychores.2004.01.004
Bahk, J., & Jung-Choi, K. (2020). The contribution of avoidable mortality to the life
expectancy gains in Korea between 1998 and 2017. International Journal of
Environmental Research and Public Health, 17(18), 6499. https://doi.org/10.3390/
ijerph17186499
Celik, S. S., Celik, Y., Hikmet, N., & Khan, M. M. (2018). Factors affecting life satisfaction
of older adults in Turkey. The International Journal of Aging and Human Development,
87(4), 392–414. https://doi.org/10.1177/0091415017740677
Chang, S. F. (2017). Frailty is a major related factor for at risk of malnutrition in
community-dwelling older adults. Journal of Nursing Scholarship, 49(1), 63–72.
https://doi.org/10.1111/jnu.12258
Cracknell, R. (2010). The ageing population: The UK’s ageing population has considerable
consequences for public services. Key Issues for the New Parliament, 3, 44–45.
Dumitrache, C. G., Rubio, L., & Rubio-Herrera, R. (2017). Perceived health status and life
satisfaction in old age, and the moderating role of social support. Aging & Mental
Health, 21(7), 751–757.
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., …
McBurnie, M. A. (2001). Frailty in older adults: Evidence for a phenotype. The
Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(3),
M146–M157. https://doi.org/10.1093/gerona/56.3.m146
J. Park et al.
Ghimire, S., Baral, B. K., Karmacharya, I., Callahan, K., & Mishra, S. R. (2018). Life
satisfaction among elderly patients in Nepal: Associations with nutritional and
mental well-being. Health and Quality of Life Outcomes, 16(1), 1–10.
Giebel, C., Hassan, S., Harvey, G., Devitt, C., Harper, L., & Simmill-Binning, C. (2020).
Enabling middle-aged and older adults accessing community services to reduce
social isolation: Community Connectors. Health & Social Care in the Community.
https://doi.org/10.1111/hsc.13228
Han, M. (2008). The 2008 national survey of older Koreans. Seoul: Ministry of Health and
Welfare, Keimyung University Industry-Academic Cooperation Team.
Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis:
A regression-based approach. Guilford Press.
Hayes, A. F. (2018). Partial, conditional, and moderated mediation: Quantification,
inference, and interpretation. Communication Monographs, 85(1), 4–40. https://doi.
org/10.1080/03637751.2017.1352100
Hsieh, T. J., Su, S. C., Chen, C. W., Kang, Y. W., Hu, M. H., Hsu, L. L., … Hsu, C. C.
(2019). Individualized home-based exercise and nutrition interventions improve
frailty in older adults: A randomized controlled trial. International Journal of
Behavioral Nutrition and Physical Activity, 16(1), 1–15. https://doi.org/10.1186/
s12966-019-0855-9
Jayanama, K., Theou, O., Blodgett, J. M., Cahill, L., & Rockwood, K. (2018). Frailty,
nutrition-related parameters, and mortality across the adult age spectrum. BMC
Medicine, 16(1), 1–23. https://doi.org/10.1186/s12916-018-1176-6
Kang, H., Chapin, R. K., & Kim, H. (2017). Social support, stress, and life satisfaction
among retired older adults in South Korea. Innovation in Aging, 1(1), 886. https://doi.
org/10.1093/geroni/igx004.3182
Kim, J., Lee, Y., Won, C. W., Lee, K. E., & Chon, D. (2018). Nutritional status and frailty in
community-dwelling older Korean adults: The Korean frailty and aging cohort study.
The Journal of Nutrition, Health & Aging, 22(7), 774–778. https://doi.org/10.1007/
s12603-018-1005-9
Kim, W.-K., & Chung, C.-W. (2019). 2014, 2017 National survey of older Koreans frailty
& applying frailty measurement. Journal of Coaching Development, 21(3), 101–110.
https://doi.org/10.47684/jcd.2019.09.21.3.101
Ko, H., & Jung, S. (2021). Association of social frailty with physical health, cognitive
function, psychological health, and life satisfaction in community-dwelling older
Koreans. International Journal of Environmental Research and Public Health, 18(2),
818. https://doi.org/10.3390/ijerph18020818
Kontis, V., Bennett, J. E., Mathers, C. D., Li, G., Foreman, K., & Ezzati, M. (2017). Future
life expectancy in 35 industrialised countries: Projections with a Bayesian model
ensemble. The Lancet, 389(10076), 1323–1335. https://doi.org/10.1016/s0140-
6736(16)32381-9
Korea National Statistical Office. (2021). Population trend survey. Available at: https://kos
is.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1B81A21&conn_path=I2
Accessed on January 3, 2022.
Korea Institute for Health and Social Affairs. (2017). Survey of Korea older adults.
Available at: http://www.mohw.go.kr/react/jb/sjb020201ww.jsp?PAR_MENU_
ID=03&MENU_ID=032901&CONT_SEQ=344953&page=1 Accessed on January 3,
2022.
Korea Institute for Health and Social Affairs. (2020). Survey of Korea older adults [Data
set] Available at: http://www.mohw.go.kr/react/jb/sjb030301vw.jsp?PAR_MENU_
ID=03&MENU_ID=032901&CONT_SEQ=366496&page=1 Accessed on January 3,
2022.
Kojima, G., Iliffe, S., Morris, R. W., Taniguchi, Y., Kendrick, D., Skelton, D. A., …
Bowling, A. (2016). Frailty predicts trajectories of quality of life over time among
British community-dwelling older people. Quality of Life Research, 25(7), 1743–1750.
https://doi.org/10.1007/s11136-015-1213-2
Kulik, C. T., Ryan, S., Harper, S., & George, G. (2014). Aging populations and
management. Academy of Management Journal, 57(4), 929–935. https://doi.org/
10.5465/amj.2014.4004
Liu, J., Wei, W., Peng, Q., & Xue, C. (2021). What can buffer the impact of social support
on Chinese older adults’ life satisfaction? Journal of Applied Gerontology, 40(10),
1260–1271. https://doi.org/10.1177/0733464820917876
Archives of Gerontology and Geriatrics 113 (2023) 105019
Ma, L., Sun, F., & Tang, Z. (2018). Social frailty is associated with physical functioning,
cognition, and depression, and predicts mortality. The Journal of Nutrition, Health &
Aging, 22(8), 989–995. https://doi.org/10.1007/s12603-018-1054-0
Mao, X., & Han, W. J. (2018). Living arrangements and older adults’ psychological well-
being and life satisfaction in china: Does social support matter? Family Relations, 67
(4), 567–584. https://doi.org/10.1111/fare.12326
Mao, S., Lu, N., & Xiao, C. (2021). Perceived neighborhood environment and depressive
symptoms among older adults living in Urban China: The mediator role of social
capital. Health & Social Care in the Community. https://doi.org/10.1111/hsc.13631
National Institutes of Health. (2018). Global health and aging.
Palomo-Vélez, G., García, F., Arauna, D., Muñoz-Mendoza, C. L., Fuentes, E., & Palomo, I.
(2020). Effects of frailty status on happiness and life satisfaction: The mediating role
of self-perceived health. Revista Latinoamericana de Psicología, 52, 95–103. https://
doi.org/10.14349/rlp.2020.v52.10
Pilotto, A., Custodero, C., Maggi, S., Polidori, M. C., Veronese, N., & Ferrucci, L. (2020).
A multidimensional approach to frailty in older people. Ageing Research Reviews, 60,
Article 101047. https://doi.org/10.1016/j.arr.2020.101047
Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing
and comparing indirect effects in multiple mediator models. Behavior Research
Methods, 40(3), 879–891. https://doi.org/10.3758/brm.40.3.879
Preacher, K. J., Rucker, D. D., & Hayes, A. F. (2007). Addressing moderated mediation
hypotheses: Theory, methods, and prescriptions. Multivariate Behavioral Research, 42
(1), 185–227. https://doi.org/10.1080/00273170701341316
Rafnsson, S. B., Shankar, A., & Steptoe, A. (2015). Longitudinal influences of social
network characteristics on subjective well-being of older adults: Findings from the
ELSA study. Journal of Aging and Health, 27(5), 919–934. https://doi.org/10.1177/
0898264315572111
Sharif, S. P., Amiri, M., Allen, K. A., Nia, H. S., Fomani, F. K., Matbue, Y. H., …
Waheed, H. (2021). Attachment: The mediating role of hope, religiosity, and life
satisfaction in older adults. Health and Quality of Life Outcomes, 19(1), 1–10. https://
doi.org/10.1186/s12955-021-01695-y
Smith, G. L., Banting, L., Eime, R., O’Sullivan, G., & Van Uffelen, J. G. (2017). The
association between social support and physical activity in older adults: A systematic
review. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 1–21.
https://doi.org/10.1186/s12966-017-0509-8
Simone, P. M., & Haas, A. L. (2013). Frailty, leisure activity and functional status in older
adults: Relationship with subjective well being. Clinical Gerontologist, 36(4),
275–293. https://doi.org/10.1080/07317115.2013.788114
Tada, A. (2018). Psychological effects of exercise on community-dwelling older adults.
Clinical Interventions in Aging, 13, 271. https://doi.org/10.2147/cia.s152939
Tsutsumimoto, K., Doi, T., Makizako, H., Hotta, R., Nakakubo, S., Kim, M., …
Shimada, H. (2018). Social frailty has a stronger impact on the onset of depressive
symptoms than physical frailty or cognitive impairment: A 4-year follow-up
longitudinal cohort study. Journal of the American Medical Directors Association, 19
(6), 504–510. https://doi.org/10.1016/j.jamda.2018.02.008
Wilhelmson, K., Fritzell, E., Eklund, K., & Dahlin-Ivanoff, S. (2013). Life satisfaction and
frailty among older adults. Health Psychology Research, 1(3). https://doi.org/
10.4081/hpr.2013.1515
Won, C. W., Yang, K. Y., Rho, Y. G., Kim, S. Y., Lee, E. J., Yoon, J. L., … Lee, Y. S. (2002).
The Development of Korean Activities of Daily Living (K-ADL) and Korean
Instrumental Activities of Daily Living (K-IADL) Scale. Journal of the Korean Geriatrics
Society, 6(2), 107–120.
Yang, F., Gu, D., & Mitnitski, A. (2016). Frailty and life satisfaction in Shanghai older
adults: The roles of age and social vulnerability. Archives of Gerontology and
Geriatrics, 67, 68–73. https://doi.org/10.1016/j.archger.2016.07.001
Zhang, J., Yu, N. X., Zhang, J., & Zhou, M. (2017). Sense of community and life
satisfaction in Chinese older adults: Moderating roles of personal and partner
resilience. Journal of Community Psychology, 45(5), 577–586. https://doi.org/
10.1002/jcop.21878