Unpacking the association of activities of daily living on self-care ability in China's rural empty-nest older adults: the chain mediation of social alienation and psychological resilience

BACKGROUND: This study investigates the associations among Activities of Daily Living (ADL), social alienation, psychological resilience, and self-care ability in rural empty-nest older adults. It further examines the chain mediating roles of social alienation and psychological resilience in the relationship between ADL and self-care ability. METHODS: Between February 2022 and March 2023, a survey was conducted among 1,025 rural empty-nest older adults in Chaoyang, Liaoning Province, China. A general information questionnaire, the Activities of Daily Living Scale, the Social Alienation Scale, the Psychological Resilience Scale, and the Self-Care Ability Scale were used as research instruments. Data analysis was performed using SPSS 27.0 and the PROCESS v4.1 macro for correlation, regression, and mediation effect analyses. RESULTS: The mean scores for ADL, social alienation, psychological resilience, and self-care ability were 21.01 ± 9.51, 42.30 ± 14.05, 129.41 ± 22.79, and 143.54 ± 19.24, respectively. ADL scores were positively correlated with social alienation scores (r = 0.113, p < 0.001) and negatively correlated with both psychological resilience (r = -0.120, p < 0.001) and self-care ability (r = -0.170, p < 0.001). Social alienation was negatively correlated with psychological resilience (r = -0.535, p < 0.001) and self-care ability (r = -0.738, p < 0.001). Psychological resilience was positively correlated with self-care ability (r = 0.780, p < 0.001). Mediation analysis indicated that social alienation and psychological resilience partially mediated the effect of ADL on self-care ability. Specifically, a chain mediation effect of social alienation and psychological resilience was confirmed in the relationship between ADL and self-care ability. CONCLUSIONS: ADL directly predicts self-care ability among rural empty-nest older adults. Additionally, ADL can indirectly affects self-care ability through the separate mediating effects of social alienation and psychological resilience, as well as through their combined chain mediation effect.