Comparing Sarcopenia , Physical, Psychological and Social Frailty in Hospitalized Older Women Congestive Heart Failure in Metropolitan and Rural Settings

• ChatGPT (Behavioral): Phase 3:In Experimental Group 1, participants will be invited to use the ICT app, which they are encouraged to engage with for at least 15 minutes daily. This app is designed to actively monitor the users' emotional status and automatically notify both the research team and family members if any negative mood is detected.
• community social (Behavioral): Phase 3:In Experimental Group 2, participants will be encouraged to increase their social participation through community-based activities, while the Control Group will continue with their routine lifestyle.

Primary outcomes

• Tilburg Frailty Indicator (TFI) [Baseline, 3-month follow-up]: Assesses multidimensional frailty across physical, psychological, and social domains using a 15-item questionnaire. It consists of two parts: the first part gathers data on determinants of frailty (e.g., age, gender, marital status), while the second part includes 15 items divided into physical (8 items), psychological (4 items), and social (3 items) domains. This instrument offers a holistic view of an individual's frailty status. The TFI has shown good internal consistency (Cronbach's α = 0.79) and predictive validity for adverse outcomes, including functional decline and mortality. Score range : 0-15 Scores 0-4 Scores: non-frail ; 5 Scores or more: frail
• Makizako Social Frailty Index [Baseline, 3-month follow-up]: Assesses social frailty through a set of 5 questions related to social participation, activities, and support networks. The questionnaire has demonstrated good test-retest reliability and criterion validity in predicting adverse health outcomes such as reduced physical activity and functional decline. These instruments collectively provide a comprehensive framework for assessing physical, psychological, and social frailty, especially in studies involving older adults. Score range : 0-5 Scores 0 Scores: non-Social Frailty ; 1. Scores : Pre-Social Frailty ; 2. Scores or more: Social Frailty
• International Physical Activity Questionnaire - Short Form (IPAQ-S) [Baseline, 3-month follow-up]: A self-reported measure assessing physical activity over the last seven days. It categorizes activity levels based on frequency and intensity, covering domains such as walking, moderate activity, and vigorous activity. Calculate MET-minutes/week Category 1: Low No activity is reported \& Activity does not meet the criteria for Moderate or High categories. Category 2: Moderate Meets any of the following: 3 or more days of vigorous activity of at least 20 min/day ; 5 or more days of moderate activity and/or walking of at least 30 min/day ; 5 or more days of any combination of walking, moderate, or vigorous activities, achieving at least 600 MET-min/week Category 3: Vigorous Meets either of the following: At least 3 days, accumulating at least 1500 MET-min/week, OR 7 or more days of any combination of activities totaling ≥3000 MET-min/week
• Minnesota Living with Heart Failure Questionnaire（MLHFQ） [Baseline, 3-month follow-up]: One of the most widely used health-related quality of life questionnaires for patients with CHF. Score range : 0-105 Scores 0-24 Scores: Low impact of heart failure on life ; 25-45 Scores: Moderate impact of heart failure on life ; 46 Scores or more: Serious impact of heart failure on life
• UCLA Loneliness Scale [Baseline, 3-month follow-up]: Measures subjective feelings of loneliness and social isolation. Score range : 6-18 Scores ; Higher total scores indicate greater feelings of loneliness.
• Geriatric Depression Scale (GDS-15) [Baseline, 3-month follow-up]: A shorter 15-item version and designed to screen for depression in older adults. Each depressive answer scores 1 point. Some items count "Yes" as a point. Some items count "No" as a point. The maximum total score is 15. Items Scored as 1 Point for a "Yes" Answer:1, 5, 7, 11, 13 Items Scored as 1 Point for a "No" Answer:2, 3, 4, 6, 8, 9, 10, 12, 14, 15 Interpretation of Scores 0-6: Normal (no depression) ; 7-10: Moderate depression ; 11-15: Severe depression
• Clinical Frailty Scale (CFS) [Baseline, 3-month follow-up]: A 9-point scale that evaluates an individual's level of frailty based on their physical functioning and overall health status. Scoring Range The scale ranges from 1 to 9, with higher scores indicating greater frailty.

Sex: All, ages: 65 Years to any

Inclusion Criteria:

* Participants must be 65 years or older.
* Diagnosis of CHF with a left ventricular ejection fraction (EF) of less than 40%
* Ability to communicate effectively in Mandarin or Taiwanese.

Exclusion Criteria:

* Patients diagnosed with unstable heart failure
* Severe Comorbidities, conditions such as end-stage renal disease, advanced hepatic dysfunction, or terminal malignancies.
* Severe cognitive deficits that impede the ability to provide informed consent or participate in study interventions.
* Uncorrected visual or hearing impairments that would hinder effective communication or interaction with the ChatGPT application.
* Active psychiatric conditions, including major depression or psychosis, that could interfere with study participation or adherence.