Frailty and malnutrition mediate the relationship between fall risk and activities of daily living in community-dwelling older women: a community-based cross-sectional study in Zunyi, China

Older women face elevated fall risk driven by frailty and malnutrition, which subsequently impairs their activities of daily living (ADL). However, research into how frailty and malnutrition modulate the fall - ADL relationship remains limited. This study aimed to explore the chain mediating role of frailty and malnutrition in the association between fall risk and ADL, to provide evidence for clinical interventions. A total of 4,157 older women were recruited via convenience sampling from 10 communities in Zunyi City, Guizhou Province. Data were collected using the General Information Questionnaire, Frailty Phenotype Scale, Chinese Falls Risk Self-Assessment Scale, Mini Nutritional Assessment-Short Form, and ADL Scale. Spearman correlation analysis and bootstrap-mediated effect tests were performed using SPSS 29.0 PROCESS macro 3.5. Fall risk, frailty, malnutrition, and ADL showed significant correlations (all P < 0.001).After adjusting for confounders, fall risk directly and negatively associated with ADL (β = -0.181, P < 0.001). Bootstrap analysis confirmed that frailty and malnutrition functioned as serial mediators via three pathways: malnutrition alone (β = -0.193), frailty alone (β = -0.405), and the sequential malnutrition→frailty pathway (β = -0.047). Total indirect effects accounted for 37.99% of the overall effect, with all 95% confidence intervals excluding zero. High fall risk in older adults women correlates with ADL decline through the dual mediating pathways of malnutrition and frailty. Integrating nutritional support and frailty management into targeted interventions may reduce fall risk and facilitate healthy aging in this population.