Yu Zhiqiang, Jiang Meng, Zhang Yueyun
Department of Social Work, School of Philosophy and Social Development, Shandong University, Jinan, China.
School of Social Sciences, Harbin Institute of Technology, Harbin, China.
Front Public Health. 2025 Jul 15;13:1630345. doi: 10.3389/fpubh.2025.1630345. eCollection 2025.
Falls and loneliness are both common during older adulthood and detrimental to older adults' health. However, it remains unclear whether and how falls may be longitudinally related to loneliness among older adults, despite some cross-sectional evidence in both Western and Chinese contexts. This study aimed to examine the longitudinal association between falls and loneliness among Chinese older adults, its potential variation across age groups, and the role of social adaptation in mediating the association.
Data were from four waves of the China Longitudinal Aging Social Survey (CLASS, 2014-2020), and random-effects regression models were applied to a sample of 31,406 person-wave observations from 11,063 respondents. Both falls and loneliness were self-reported. Mediation analysis was conducted using the Baron and Kenny method and Bootstrapping procedures.
First, falls were associated with higher levels of loneliness ( < 0.001). Second, the association differed by age group, with its magnitude being higher for the young-old (aged 60-69) ( < 0.05) and the oldest-old (aged 80 and over) ( < 0.01) than for the old-old (aged 70-79). Third, social adaptation played a mediating role (accounting for 10% of the total effect), that is, falls resulted in decreased social adaptation which further increased loneliness.
These findings enrich our understanding of the pivotal role of falls in shaping the psychological well-being of older adults. In terms of policy relevance, falls prevention programs should be integrated into mental health initiatives for older adults, recognizing falls not merely as physical health events but as potential triggers for loneliness.
跌倒和孤独在老年人中都很常见，且对老年人的健康有害。然而，尽管在西方和中国背景下都有一些横断面证据，但跌倒与老年人孤独感之间是否存在纵向关联以及如何关联仍不清楚。本研究旨在探讨中国老年人跌倒与孤独感之间的纵向关联、其在不同年龄组中的潜在差异，以及社会适应在介导这种关联中的作用。
数据来自中国老年社会追踪调查（CLASS，2014 - 2020）的四轮调查，对11,063名受访者的31,406人次观测样本应用随机效应回归模型。跌倒和孤独感均为自我报告。使用Baron和Kenny方法以及Bootstrapping程序进行中介分析。
首先，跌倒与更高水平的孤独感相关（<0.001）。其次，这种关联因年龄组而异，年轻老年人（60 - 69岁）（<0.05）和高龄老年人（80岁及以上）（<0.01）的关联程度高于老年老年人（70 - 79岁）。第三，社会适应起到了中介作用（占总效应的10%），即跌倒导致社会适应能力下降，进而进一步增加孤独感。
这些发现丰富了我们对跌倒在塑造老年人心理健康方面关键作用的理解。在政策相关性方面，预防跌倒项目应纳入老年人心理健康倡议，认识到跌倒不仅是身体健康事件，而且是孤独感的潜在触发因素。
