Loneliness and cognitive function among Chinese older adults: multiple mediating effects of activities of daily living and anxiety

BACKGROUND: Several studies have found that loneliness is a key factor affecting cognitive function. However, the underlying mechanism of activities of daily living (ADL) and anxiety in this effect have not been investigated. This study aims to explore the mediating effects of ADL and anxiety on the relationship between loneliness and cognitive function among Chinese older adults. METHODS: In this study, 10,026 older people aged 60 and above were included based on the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Cognitive function, anxiety, ADL, and loneliness were evaluated using the mini-mental state examination, the 7-item generalized anxiety disorder scale, the Katz index scale, and the single-item, respectively. The mediation analysis was then conducted using the PROCESS macro method and multiple regression analysis. RESULTS: It was observed that the overall proportion of older adults with cognitive impairment was 25.3%. Loneliness, ADL, and anxiety showed significantly negative correlations with cognitive function, with a correlation coefficient of -0.144, -0.615 and -0.105, respectively. The indirect effects of ADL and anxiety on the relationship between loneliness and cognitive function were -0.1159 and -0.0708, respectively, which represented 30.0% and 18.3% of the total effect, respectively. The serial indirect effect of ADL and anxiety was -0.0008, accounting for only 0.2% of the total effect. CONCLUSION: This study demonstrated the necessity of addressing the status of cognitive impairment among Chinese older adults. ADL and anxiety may independently and accumulatively mediate the relationship between loneliness and cognitive function.