| Summary: | • As older people with HIV face the combined pressures of aging and HIV, they may become less connected to the broader social environment, making family a critical source of support for coping with stress. • Family functioning serves as a kind of social support, helps individuals cope with the stress and challenges posed by diseases and prevents the development of unhealthy emotions. • Social vulnerability has been shown to be associated with increased disruptions in family functioning. • This study shows that depression and social vulnerability (including social isolation and loneliness) mediate the relationship between family functioning and multidimensional frailty. • Family functioning significantly influences multidimensional frailty among older PWH, with social vulnerability and depression acting as mediating factors. This study explored the influence of family functioning on frailty among older people with HIV (PWH) and the mediating roles of social vulnerability and depression. A quantitative cross-sectional study. A cross-sectional survey of older PWH from December 2022 to October 2023 was carried out in Shanghai, China. Data on sociodemographics, family functioning, social vulnerability (social isolation and loneliness), depression and multidimensional frailty were gathered and analyzed by structural equation modeling (SEM). Analysis was performed via SPSS 24.0 and AMOS 23.0. Family functioning affects older PWH's frailty through three indirect paths: through the mediating role of social vulnerability and depression separately and through the chain-mediating role of both social vulnerability and depression. Family functioning in older PWH is associated with multidimensional frailty, which is mediated by social vulnerability and depression. Based on these findings, targeted interventions focusing on improving family functioning, reducing social vulnerability, and alleviating depression may effectively prevent and mitigate frailty, thereby promoting health and wellbeing among older PWH.
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