Social alienation and cognitive function among older adults: the mediating roles of ruminative thinking and self-neglect

BACKGROUND: Cognitive decline has become a major public health concern in the context of global population aging. Social alienation has been identified as a significant modifiable factor associated with cognitive impairment. Although previous studies have suggested that depression mediates the association between social alienation and cognitive function, depression is a multidimensional construct. The specific social-psychological-behavioral associations underlying this relationship remain unclear. This study aimed to examine the mediating associations of ruminative thinking and self-neglect in the relationship between social alienation and cognitive function, based on the stress process model, and to conduct an exploratory reversed-model analysis involving self-neglect and cognitive function. METHODS: A cross-sectional study design was employed. From May to November 2025, 340 older adults were recruited in Anhui Province, China. The Generalized Alienation Scale, Ruminative Responses Scale, The Scale of the Elderly Self-Neglect, and Montreal Cognitive Assessment were used. Data analysis was conducted using SPSS and AMOS. Structural equation modeling (SEM) was conducted, and the mediating associations were examined using the bootstrap method. RESULTS: Cognitive function was negatively correlated with social alienation (r = -0.749, p < 0.01), ruminative thinking (r = -0.724, p < 0.01), and self-neglect (r = -0.742, p < 0.01). The estimated total association between social alienation and cognitive function included a direct association (β = -0.364, 95% CI = -0.606,-0.178) and an indirect association (β = -0.456, 95% CI = -0.643,-0.269). The sequential indirect association involving ruminative thinking and self-neglect was statistically significant (β = -0.091, 95% CI = -0.232,-0.017), accounting for 11.10% of the estimated total association. The exploratory reversed model showed comparable fit, with a significant reversed sequential indirect association (β = 0.120, 95% CI = 0.023, 0.283). CONCLUSION: This study identified a potential socio-psychological-behavioral pattern linking social alienation, ruminative thinking, self-neglect, and cognitive function in older adults. The reversed model suggested that the temporal ordering between self-neglect and cognitive function could not be definitively established. These findings suggest that public health strategies aimed at promoting cognitive health may consider integrating social participation enhancement, psychological support, behavioral guidance, and cognitive risk screening.