{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:01:22Z","timestamp":1790136082652,"version":"4.0.1"},"reference-count":52,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing &amp; Health Sciences"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>This study aims to examine the relationship between symptom clusters (depressive symptoms, sleep disturbances, and pain) and frailty in older adults, with a specific focus on mediation and moderation effects. Data from two cross\u2010sectional studies in Changsha and Hong Kong were analyzed, including nursing home residents without cancer and older adults with cancer. Study\u2010stratified analyses were conducted in SPSS 26.0 and PROCESS, with adjustment for available covariates. Mediation tested whether sleep disturbances were indirectly associated with depressive symptoms and frailty, and moderated mediation examined whether pain severity or interference conditioned the association between depressive symptoms and sleep disturbances. In both groups, frailty, depressive symptoms, sleep disturbances, and pain were significantly associated. Sleep disturbances showed a significant indirect association between depressive symptoms and frailty in both groups. Pain interference, but not pain severity, moderated the association between depressive symptoms and sleep disturbances only among older adults without cancer. The findings highlight the importance of assessing and managing depressive symptoms, sleep disturbances, and pain\u2010related interference when addressing frailty in older adults, particularly among those without cancer.<\/jats:p>","DOI":"10.1111\/nhs.70406","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:20:48Z","timestamp":1785730848000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Symptom Clusters and Frailty Among Older Adults With and Without Cancer: Insights From Two Cross\u2010Sectional Studies"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7204-0998","authenticated-orcid":false,"given":"Tianxue","family":"Hou","sequence":"first","affiliation":[{"name":"School of Nursing, Li Ka Shing Faculty of Medicine, the University of Hong Kong  Pok Fu Lam Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8741-9271","authenticated-orcid":false,"given":"Denise Shuk Ting","family":"Cheung","sequence":"additional","affiliation":[{"name":"School of Nursing, Li Ka Shing Faculty of Medicine, the University of Hong Kong  Pok Fu Lam Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9443-4082","authenticated-orcid":false,"given":"Mu\u2010Hsing","family":"Ho","sequence":"additional","affiliation":[{"name":"School of Nursing, Li Ka Shing Faculty of Medicine, the University of Hong Kong  Pok Fu Lam Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3374-1078","authenticated-orcid":false,"given":"Tongyao","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Nursing, Li Ka Shing Faculty of Medicine, the University of Hong Kong  Pok Fu Lam Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9551-0991","authenticated-orcid":false,"given":"Chia\u2010Chin","family":"Lin","sequence":"additional","affiliation":[{"name":"School of Nursing, Li Ka Shing Faculty of Medicine, the University of Hong Kong  Pok Fu Lam Hong Kong"},{"name":"Alice Ho Miu Ling Nethersole Charity Foundation  Tai Po New Territories Hong Kong"},{"name":"Research Unit for Enhancing Well\u2010Being in Vulnerable and Chronic Illness Populations, Faculty of Nursing Chulalongkorn University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,2]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/(sici)1099\u20101166(199910)14:10<858::aid\u2010gps35>3.0.co;2\u20108"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev\u2010psych\u2010030122\u2010124119"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2017.01.032"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006199-200609000-00009"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1188\/05.ONF.E48-E55"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2022.998401"},{"issue":"1","key":"e_1_2_14_8_1","first-page":"37","article-title":"Putative Mechanisms of Action of Antidepressant Drugs in Affective and Anxiety Disorders and Pain","volume":"26","author":"Blier P.","year":"2001","journal-title":"Journal of Psychiatry & Neuroscience"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2021.633959"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532\u20105415.2009.02671.x"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0165\u20101781(89)90047\u20104"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1237470"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2010.03.002"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1517\/14728222.2014.855720"},{"issue":"2","key":"e_1_2_14_15_1","first-page":"129","article-title":"Pain Assessment: Global Use of the Brief Pain Inventory","volume":"23","author":"Cleeland C. 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