Serial Mediation Pathways Linking Physical Performance to EQ-VAS-Assessed Self-Rated Health in Older Inpatients

Abstract

Background/Objectives: This study examined patterns of cross-sectional indirect associations involving cognitive status, depressive symptoms, and functional status in the relationship between Tinetti Mobility Test (TMT)-assessed balance and gait performance and self-rated health assessed with the EuroQol Visual Analogue Scale (EQ-VAS) in older inpatients. Methods: The study included 287 Romanian inpatients aged ≥65 years. Depressive symptoms, cognitive status, and functional status were assessed using the 15-item Geriatric Depression Scale (GDS-15), Mini-Mental State Examination (MMSE), and Lawton Instrumental Activities of Daily Living (IADL) scale, respectively. Mediation analysis was performed using the PROCESS macro v4.3.1 for SPSS. Model 80 was used with 5000 bootstrap samples and adjusted for sex, age, residence, and obesity. Results: Compared with participants in the impaired balance and gait group (scores 0–23), those in the unimpaired balance and gait group (scores 24–28) showed positive indirect associations with EQ-VAS scores through depressive symptoms (B = 0.540, Bootstrap 95% CI: [0.170, 1.064]), cognitive status (B = 0.557, Bootstrap 95% CI: [0.048, 1.373]), and functional status (B = 0.796, Bootstrap 95% CI: [0.218, 1.510]), and through serial pathways involving depressive symptoms followed by IADL (B = 0.067, Bootstrap 95% CI: [0.001, 0.191]) and cognitive status followed by IADL (B = 0.224, Bootstrap 95% CI: [0.016, 0.554]). Conclusions: TMT-assessed balance and gait performance was associated with EQ-VAS-assessed self-rated health through several model-specified psychological, cognitive, and functional pathways. These cross-sectional, model-dependent findings do not establish temporal ordering or causal mediation and apply to global self-rated health rather than the full multidimensional construct of health-related quality of life.