| ObjectivesThe present study aimed to investigate the status of social isolation in community-dwelling older adults and explore its influencing factors;to analyze the correlation between social isolation,depression,activities of daily living and quality of life.Furthermore,based on the two mediating variables of depression and activities of daily living,the internal mechanism of social isolation on quality of life was explored.Thus,this study provides a scientific reference for identifying and screening the status of social isolation timely in the elderly,clarifying the harm of social isolation to their health and quality of life,implementing personalized intervention management effectively to prompt their physical and mental health,as well as the quality of life.MethodsIn this study,610 community-dwelling older adults aged 60 years and above were recruited from six communities in Qingdao from April 2019 to November 2019 by adopting a convenient sampling method.Data was collected with a general information questionnaire,the Lubben Social Network Scale-6(LSNS-6),the Social Support Rating Scale(SSRS),the Geriatric Depression Scale-15(GDS-15),the Activities of Daily Living Scale(ADLs)and the Mos 36-item Short Form Health Survey(SF-36).SPSS 24.0,AMOS 24.0 software and PROCESS program were used for data entry and statistical analysis.Qualitative data were expressed as frequency and constituent ratio(%),while quantitative data were expressed as mean ± standard.The chi-square test was adopted to conduct univariate analysis on the influential factors of social isolation in the elderly,and Logistic regression analysis was used to conduct multivariate analysis.Pearson correlation analysis was used to analyze the correlation between social isolation,depression,activities of daily living and quality of life.Stepwise regression method was used to test the mediating effect of depression and activities of daily living,and simple path analysis was performed.The structural equation model was constructed and verified to clarify the mechanism of social isolation on quality of life.Results1.The total score of social isolation in community-dwelling older adults was(14.95±4.58),which was at a high risk level.There were 176 subjects were socially isolated,and the prevalence rate of social isolation was 29.73%.Among them,the score of family isolation dimension was(8.52±1.77),73 participants were family-isolated,and the prevalence was 12.33%.The score of friends isolation dimension was(6.22±3.65),and 249 participants were friend-isolated,and the prevalence was 42.06%.2.Univariate analysis showed that different gender,age,education level,marital status,living arrangement,the number of living children,pre-retirement occupation,medical cost burden,the number of chronic diseases,self-evaluation of health,exercise habit,personality,activities of daily living,depression status,social participation,community type,community settings and the social support status had statistically significant effects on social isolation among community-dwelling older adults(all P<0.05).Logistic regression analysis revealed that male,old age,having heavy medical cost burden,never doing exercise,having no social participation,living in old town communities,depression and having a low level of social support were risk factors of social isolation;having 3 children was a protective factor(all P<0.05).3.The score of depression was(5.19±3.13)in community-dwelling older adults,with135 participants in depression symptoms accounting for 22.80%.The score of activities of daily living was(15.52±2.75),with 136 participants(22.97%)had different degrees of dysfunction,45 participants(7.60%)had obvious dysfunction.The total score of quality of life was(113.02±10.56),and the score of PCS was(61.77±13.02)and MCS was(71.06±13.89).4.Correlation analysis exhibited that the total score of social isolation was positively correlated with the total score of quality of life(r=0.630,P<0.01),and negatively correlated with the total score of depression and activities of daily living(r=-0.701,P<0.01;r=-0.620,P<0.01);the total score of depression was positively related to the score of activities of daily living(r=0.550,P<0.01),and negatively related to the total score of quality of life(r=-0.727,P<0.01);the score of activities of daily living was negatively related to the total score of quality of life(r=-0.604,P<0.01).5.Structural equation model suggested that the total effect of social isolation on the quality of life was 0.877,and there were three influencing paths:(1)social isolation could directly affect the quality of life in community-dwelling older adults,the direct effect was0.414,accounting for 47.21% of the total effect [(0.414/0.877)*100%];(2)social isolation could indirectly affect the quality of life through the partial mediating effect of depression,the indirect effect was 0.244,accounting for 27.82% of the total effect [(0.244/0.877)*100%];(3)social isolation could also indirectly affect the quality of life through the partial mediating effect of activities of daily living,the indirect effect was 0.219,accounting for 24.97% of the total effect [(0.219/0.877*100%].Conclusions1.The prevalence of social isolation in community-dwelling older adults is high,and the prevalence of friends isolation is significantly higher than that of family isolation.The situation of social isolation among the elderly people is not optimistic.2.The main influencing factors of social isolation in community-dwelling older adults are gender,age,medical cost burden,exercise habits,social participation,community type,depression,social support level and the number of living children.3.Among community-dwelling elderly people,the depression emotion is common,the activities of daily living is poor,and their quality of life is at the general level.4.Significant correlations were found between social isolation,depression,activities of daily living and quality of life.The lower the score of social isolation,meaning the higher the risk of it,and the worse the level of depression and activities of daily living,as well as the lower the level of quality of life;the lower the score of depression and activities of daily living,the higher the level of quality of life.5.Social isolation can not only affect the quality of life of the elderly individuals directly,but also affect it through the partial mediating roles of depression and activities of daily living indirectly;depression and poor activities of daily living can aggravate the negative impact of social isolation on the quality of life of the elderly individuals. |
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