Adaptation to Chronic Disease as a Mediator Between Health Literacy and Frailty in Older Adults: Implications for Public Health Nursing Practice

OBJECTIVE: To examine whether adaptation to chronic disease mediates the relationship between health literacy and frailty among older adults with chronic illnesses. DESIGN: A cross-sectional design. SAMPLE: The study included 398 older adults aged 65 years and over attending routine outpatient visits at a public hospital in western Türkiye. MEASUREMENTS: Data were collected through face-to-face interviews using the Turkish Health Literacy Scale-32 (THLS-32), Adaptation to Chronic Disease Scale (ACDS), and FRAIL Scale. Correlation and mediation analyses were conducted performed with bootstrapping (5000 resamples). RESULTS: Nearly half of the participants (46.0%) had inadequate health literacy, and 53.8% were classified as frail. Health literacy was positively correlated with adaptation to chronic disease (r = 0.425, p < 0.001) and negatively correlated with frailty (r = -0.356, p < 0.001). Adaptation to chronic disease was negatively associated with frailty (r = -0.385, p < 0.001). Mediation analysis showed that adaptation to chronic disease partially mediated the relationship between health literacy and frailty (β = -0.030, 95% CI [-0.038, -0.023]). CONCLUSIONS: Adaptation to chronic disease was found to partially mediate the association between health literacy and frailty in older adults. Enhancing health literacy through nurse-led education and counseling may support adaptation and may contribute to frailty prevention among older adults.