Introduction
Self-neglect refers to the inability or unwillingness of older adults to meet essential self-care needs, leading to significant risks to their physical health, mental well-being, social functioning, and overall safety [1]. In Western countries, self-neglect is commonly characterized by the failure to provide oneself with adequate food, clothing, necessary medications, and access to clean water [2]. In contrast, in the Chinese cultural context, where society places greater emphasis on collectivism and family bonds, older adults are more likely to rely on family or social support. As a result, self-neglect in China often manifests as neglect of medical care, personal and environmental hygiene, emotional well-being, social interactions, and safety, especially when external support is insufficient or absen [3, 4]. Previous research has indicated that self-neglect in older adults can lead to adverse health outcomes such as malnutrition, depression, disability, and cognitive decline [1, 3, 5]. These outcomes negatively impact older adults’ quality of life and hinder their process of healthy aging by reducing psychological resilience, exacerbating social isolation, and impairing their ability to manage daily living activities [6].
The urgency to address self-neglect is magnified by global aging trends. According to the World Health Organization, the global population of individuals aged 60 or older is expected to reach 1.4 billion by 2030 and 2.1 billion by 2050 [7]. In China, this demographic shift is particularly pronounced, with older adults aged 60 or above accounting for 18.7% of the population [8], The proportion of rural older adults living alone rose from 8.4% in 2000 to 17.0% in 2020, exceeding the national average of 15.7% [9]. Rural aging populations in China face unique vulnerabilities to self-neglect due to a combination of social, economic, and systemic factors. Specifically, population migration and urbanization have led to limited family support for rural older adults, as many live alone without close contact with family members or caregivers for extended periods [10]. This lack of family support results in inadequate emotional care and practical assistance from children or spouses [9, 11]. Additionally, rural older adults often experience significant barriers to accessing healthcare services, stemming from fewer medical resources and underdeveloped healthcare infrastructure compared to urban areas [12]. Cultural practices in rural areas, such as a strong emphasis on self-reliance and reluctance to seek external help, may further exacerbate self-neglect [13]. Economically, rural-urban disparities contribute to financial difficulties among rural older adults, limiting their ability to afford necessary medical care or maintain their living environments [14]. These combined factors make rural older adults particularly susceptible to self-neglect, with more severe consequences for their health and well-being. Therefore, understanding and addressing self-neglect in rural areas is critical for developing effective interventions and ensuring equitable aging support systems in China. According to a study by Yi et al. [15], the prevalence of self-neglect among rural older adults who live alone is as high as 33.3%. This is significantly higher than that of older adults who live alone in urban communities in Korea (22.8%) and China (23.2%), as reported by Lee and Kim [16] and Yu et al. [17], respectively. Given the vulnerability and susceptibility of rural older adults who live alone, examining potential risk factors and mechanisms of self-neglect is crucial for developing targeted interventions and coping strategies. However, existing research on self-neglect in this demographic remains limited, particularly regarding the specific pathways through which social and psychological factors influence self-neglect behaviors.
Anzeige
Social isolation refers to a situation where an individual is disconnected from society, with limited social networks and reduced social participation and interaction [18]. Previous research has shown that social isolation is a significant factor contributing to elder self-neglect [19, 20]. Social capital theory highlights the importance of social networks, suggesting that individuals with stronger social connections are more likely to have access to valuable health-related information, resources, and support, promoting positive health behaviors. In contrast, socially isolated older adults may lack these resources, limiting their ability to engage in self-care [21] and eventually increasing the risk of self-neglect behaviors. Therefore, we hypothesize that social isolation positively predicts self-neglect among rural older adults living alone (H1).
In addition, aging attitudes are critical factors influencing health behaviors in older adults [22]. These attitudes encompass positive and negative perceptions of physiological changes, psychological functioning, and social roles during the aging process, and are influenced by cultural and societal factors [23]. Social influence theory suggests that cultural and societal factors, such as rural-urban disparities or ageist stereotypes, shape older adults’ views on aging [24‐26]. In the Chinese cultural context, traditional Confucian values, such as filial piety, emphasize respect and care for older adults, which can positively influence their self-esteem and aging attitudes. However, these values are increasingly challenged by modernization and urbanization, particularly in rural areas where younger family members migrate to cities for work, leaving elderly individuals feeling abandoned and socially isolated. This demographic shift exacerbates the rural-urban divide and diminishes the practical support systems traditionally provided by family members [27].Negative stereotypes and biases towards older individuals may be internalized, reducing self-esteem and self-worth, which discourages proactive health behaviors and fosters self-neglectful tendencies [28]. For example, older adults with a positive aging attitude are more likely to engage in healthy practices, such as regular exercise and maintaining household tasks [29], while those with negative aging attitudes may avoid seeking medical care, fail to adhere to prescribed treatments, or neglect personal hygiene, behaviors contributing to self-neglect [30‐32]. Furthermore, a grounded theory study found that Chinese rural older adults with negative aging attitudes tend to feel more vulnerable and exhibit traits such as low self-esteem, sensitivity, suspicion, and self-isolation, all of which contribute to self-neglect behaviors [33]. Although prior studies have highlighted the influence of aging attitudes on health behaviors, empirical research specifically examining the relationship between aging attitudes and self-neglect in rural older adults remains lacking. Therefore, we hypothesize that positive aging attitudes negatively predict self-neglect among rural older adults living alone (H2).
Furthermore, social isolation may exacerbate the impact of negative aging attitudes on self-neglect. Studies have shown that social isolation in older adults may lead to negative attitudes towards aging [34, 35]. Older adults who are socially isolated may have fewer opportunities to challenge negative stereotypes through positive social interactions and are more likely to internalize these beliesfs, leading to lower self-esteem and increasing the likelihood of self-neglect [36]. Previous studies have shown that socially isolated older adults, particularly those living alone, are at a heightened risk of negative aging attitudes and self-neglect. For instance, rural older adults with limited social interaction may experience loneliness and a reduced sense of belonging, which can further decrease their self-worth and reinforce negative views about aging [37]. This vulnerability increases the likelihood of self-neglect behaviors such as inadequate self-care, isolation, and neglecting health-related needs [38‐40]. Thus, we hypothesize that social isolation negatively impacts aging attitudes (H3) and aging attitudes mediate the relationship between social isolation and self-neglect among rural older adults living alone (H4).
Previous research has primarily examined the relationships between social isolation and self-neglect, as well as between social isolation and aging attitudes [41, 42]. However, the direct association between aging attitudes and self-neglect remains underexplored, particularly among rural older adults living alone. Furthermore, the mediating role of aging attitudes in the relationship between social isolation and self-neglect has received limited scholarly attention. Rural older adults living alone face unique challenges, as structural and cultural factors amplify their susceptibility to social isolation, potentially fostering negative aging attitudes and increasing the risk of self-neglect. This cross-sectional study seeks to address these gaps by investigating the interplay among social isolation, aging attitudes, and self-neglect in this vulnerable population. This study’s findings could inform policies and community interventions targeting the well-being of vulnerable older adults in rural areas, thereby boosting positive aging attitudes, reducing self-neglect behaviors, and ultimately promoting healthier aging.
Anzeige
Methods
Design and participants
This cross-sectional study employed a convenience sampling method to recruit rural older adults living alone for a questionnaire survey conducted between December 2022 and February 2023 in Guizhou Province, Southwest China. Participants were drawn from eight administrative regions, including five municipal-level cities (Zunyi, Liupanshui, Anshun, Bijie, Tongren) and three autonomous prefectures (Qiandongnan Miao and Dong Autonomous Prefecture, Qiannan Buyi and Miao Autonomous Prefecture, and Qianxinan Buyi and Miao Autonomous Prefecture). These regions were selected to reflect the diversity of economic conditions and cultural backgrounds across Guizhou Province. The sample included areas with relatively advanced economies (e.g., Zunyi) and less developed rural regions (e.g., Tongren and the autonomous prefectures). Representation of both Han Chinese and ethnic minority groups, such as Miao, Dong, and Buyi, ensured the sample captured the cultural diversity of rural populations. While convenience sampling was used, the inclusion of diverse regions enhanced the representativeness of the sample and minimized potential biases.
To be eligible for inclusion, participants were required to meet the following criteria: (1) aged 60 years or older; and (2) residing in rural areas with a documented history of living alone for at least three months. Individuals were excluded if they met any of the following criteria: (1) Severe Health Conditions: Individuals with significant physical or mental illnesses that severely impaired their cognitive or self-care abilities, thereby limiting their capacity to engage in daily activities. (2) Communication Impairments: Individuals with pronounced dialectical accents or severe hearing or visual impairments that hindered effective communication.
Sample size calculation
We determined the sample size using M. Kendall’s method [43], which involves estimating the number of participants as 5 to 10 times the maximum number of variables. In our study, which featured a maximum of 11 variables, we accounted for a 20% exclusion rate for invalid questionnaires. Therefore, our study aimed to recruit a minimum of 69 to 139 participants. In practice, we successfully enrolled 499 participants, meeting the study’s requirements.
Ethical consideration
The study was approved by the Ethics Committee of Guizhou Medical University (Approval No. 2022294). All participants provided informed consent, willingly and voluntarily, before participating in the study.
Instruments
Demographic information questionnaire
A self-designed questionnaire was used to collect demographic information, including age, gender, ethnicity, religious belief, education level, self-reported financial condition, multiple chronic diseases, and chronic pain.
Scale of the elderly self-neglect (SESN)
The SESN, developed by Zhao [44], was specifically designed to evaluate self-neglect among older adults in rural China. This scale comprises five dimensions and 14 items rated on a four-point Likert scale (ranging from 0 to 3). The dimension scores are summed to obtain the total score for self-neglect, which ranges from 0 to 42. A higher total score indicates a more severe level of self-neglect. This tool was developed based on the characteristics of rural older adults in China and has been validated among rural and community-dwelling older adults in China [45], demonstrating good applicability and reliability. In our study, the Cronbach’s alpha coefficient of the SESN was 0.752, indicating acceptable internal consistency.
Lubben social network scale-6 (LSNS-6)
The LSNS-6, developed by Lubben et al. [46] and adapted for the Chinese population by Chang et al. [47], is a widely recognized tool for assessing the structural characteristics of an individual’s family and friend networks, as well as the supportive functions provided by these networks. The scale consists of six items divided into two dimensions: family network and friend network. Each item is rated on a scale from 0 to 5, with the total score ranging from 0 to 30. A total score below 12 indicates social isolation, while scores below 6 for either the family network or friend network suggest isolation within that specific dimension.This tool has been validated and widely applied, particularly among rural older adults in China, demonstrating strong reliability and applicability in this population [37]. In our study, the Cronbach’s alpha for the LSNS-6 was 0.862, indicating excellent internal consistency.
Attitudes to ageing questionnaire (AAQ)
The AAQ, originally developed by Laidlaw et al. [48]and adapted for the Chinese population by Huang et al. in 2010 [49], is a widely used instrument to assess older adults’ aging attitudes. The scale comprises three dimensions: psychosocial loss, physical change, and psychological growth, with a total of 24 items rated on a 5-point Likert scale. The total score for aging attitudes uses 72 as the median value, where scores ≥ 72 indicate positive aging attitudes, and scores < 72 reflect negative aging attitudes. This tool has been validated among rural older adults in China [50], demonstrating good reliability and applicability in this population. In our study, the Cronbach’s alpha coefficient for this scale was 0.781, indicating acceptable internal consistency.
Data collection
For data collection, we engaged 50 university students from Guizhou Province with rural household registration. They received rigorous training in questionnaire survey methods at Guizhou Medical University. These students returned to their hometowns during winter holidays to conduct one-on-one household surveys with local older adults.
To ensure data accuracy and consistency, we provided uniform training and a standardized guide to all enumerators. Enumerators meticulously explained and recorded respondents’ answers, minimizing errors. For data quality assurance, we implemented a two-tier review process. Initially, each team conducted cross-audits within their group to identify any inconsistencies. Subsequently, project group leaders carried out a secondary review. Questionnaires deemed unsatisfactory during the secondary review were disqualified and could not be revisited with respondents.
Two of the 505 questionnaires collected did not meet quality standards, resulting in a final dataset of 499 valid questionnaires and a 98.8% valid rate.
Statistical methods
The Gaussian distribution of the data was assessed using the Kolmogorov-Smirnov (K-S) single-sample test and a P-P plot. The data were non-normally distributed. Descriptice statistics, including frequency, percentage, median, and interquartile range (IQR) were used to analyze participants’ general demographic characteristics and their scores on aging attitudes, social isolation, and self-neglect. Mann-Whitney test and Kruskal-waills test were used to compare variations in self-neglect among participants based on their general demographic characteristics. Spearman correlation analysis was performed to investigate the associations between the three variables: aging attitudes, social isolation, and self-neglect. Harman’s single-factor test was employed to assess common method bias arising from self-reported data [51]. Model 4, which was performed through the PROCESS 3.5 macro program [52], was employed to explore the mediating role of aging attitudes between social isolation and self-neglect among older adults living alone in rural areas while controlling for all statistically significant covariates identified in the general demographic analysis. PROCESS 3.5 was chosen because it is widely used, easy to operate, and its bootstrap method is well-suited for datasets with potential non-normal distributions. To assess the impact of aging attitudes and social isolation on self-neglect among older adults living alone in rural areas, a bias-corrected percentile bootstrap distribution with 95% confidence interval was calculated based on 5,000 bootstrap samples [53]. A mediation effect was considered statistically significant if the confidence interval for the indirect effect did not encompass zero. Statistical significance was set at a p-value < 0.05. All statistical analysis was performed using SPSS 27.0, and PROCESS Macro.
Anzeige
Results
Common method bias tests
The Harman single-factor test and exploratory factor analysis were performed on the data measuring social isolation, aging attitudes, and self-neglect. The analysis identified 11 factors with eigenvalues > 1, with the first factor accounting for 17.441% of the total variance, well below the 40% threshold [51], indicating no significant common method bias.
Descriptive characteristics and comparison of self-neglect
A total of 499 rural older adults living alone were included in this study. Among them, 260 (52.1%) were 60–74, while 239 (47.9%) were 75 or older. Gender distribution revealed that 199 (39.9%) were male, and 300 (60.1%) were female. The primary reason for living alone was that 319 older individuals could not receive care from their children, representing the most significant proportion at 63.9%. The univariate analysis results showed that there were significant differences in self-neglect among rural old adults living alone across various genders, ethnicities, and self-reported financial conditions (P < 0.05). More details are presented in Table 1.
Table 1
Demographic characteristics and comparison of self-neglect among older adults living alone in rural China (N = 499)
Variable | N (%) | Self-neglect (M(Q25,Q75)) | statistic | P |
|---|---|---|---|---|
Age (years) | -0.23a | 0.815 | ||
60–74 | 260 (52.10) | 10.00 (8.00, 14.00) | ||
≥ 75 | 239 (47.90) | 11.00 (8.00, 15.00) | ||
Gender | -3.01a | 0.003 | ||
Female | 300 (60.12) | 10.00 (7.75, 13.00) | ||
Male | 199 (39.88) | 11.00 (8.00, 15.00) | ||
Ethnicity | -1.98a | 0.048 | ||
Han | 235 (47.09) | 11.00 (8.00, 15.00) | ||
Ethnic minorities | 264 (52.91) | 10.00 (8.00, 14.00) | ||
Religious Belief | -0.43a | 0.664 | ||
No | 476 (95.39) | 10.50 (8.00, 14.00) | ||
Yes | 23 (4.61) | 10.00 (8.00, 13.00) | ||
Education Level | 0.87b | 0.648 | ||
No formal education | 283 (56.71) | 11.00 (8.00, 14.00) | ||
Primary school | 173 (34.67) | 10.00 (8.00, 14.00) | ||
Middle school and above | 43 (8.62) | 11.00 (8.00, 15.00) | ||
Self-reported Financial Condition | -3.41a | < 0.001 | ||
Meeting Needs | 387 (77.56) | 10.00 (8.00, 14.00) | ||
Falling Short | 112 (22.44) | 12.00 (9.00, 15.00) | ||
Multiple Chronic Diseases (≥ 2 types) | -1.87a | 0.062 | ||
No | 263 (52.71) | 10.00 (7.00, 14.00) | ||
Yes | 236 (47.29) | 11.00 (8.00, 15.00) | ||
Chronic pain | -1.81a | 0.071 | ||
No | 165 (33.07) | 10.00 (7.00, 14.00) | ||
Yes | 334 (66.93) | 11.00 (8.00, 14.00) |
Scores and spearman correlation analysis of aging attitudes, social isolation and self-neglect
Among older adults living alone in rural areas, the score of social isolation was 16.00 (12.00, 21.00), the score of aging attitudes was 75.00 (69.00, 82.00), and the score of self-neglect was 10.00 (8.00, 14.00), respectively. Spearman correlation analysis showed that the score of aging attitudes positively correlated with that of social isolation (r = 0.353, P < 0.05) and negatively correlated with that of self-neglect (r = -0.367, P < 0.05). Besides, the score of social isolation was negatively correlated with that of self-neglect (r = -0.371, P < 0.05), as shown in Table 2.
Anzeige
Table 2
Scores and spearman correlation analysis of aging attitudes, social isolation and self-neglect (N = 499)
Variable | M (Q25, Q75) | Social isolation | Aging attitudes | self-neglect |
|---|---|---|---|---|
Social isolation | 16.00 (12.00, 21.00) | 1 | ||
Aging attitudes | 75.00 (69.00, 82.00) | 0.353*** | 1 | |
Self-neglect | 10.00 (8.00, 14.00) | -0.371*** | -0.367*** | 1 |
Mediation analysis of aging attitudes between social isolation and self-neglect
The results indicated that the total effect between social isolation and self-neglect was − 0.273 (95% CI: -0.348 to -0.199, p < 0.001). The regression coefficients for social isolation with aging attitudes and self-neglect were 0.564 (p < 0.001) and − 0.136 (p < 0.001), respectively (Table 3). After controlling for gender, ethnicity, and self-reported financial condition, the mediation analysis showed that the indirect effect was − 0.077 (95% CI: -0.109 to -0.050, p < 0.001), with a 95% confidence interval excluding 0, signifying statistical significance. This confirmed the established mediating effect of aging attitudes between social isolation and self-neglect. When aging attitudes were introduced as a mediator, the direct effect of social isolation on self-neglect remained significant at -0.196 (95% CI: -0.273 to -0.125, p < 0.001), indicating a partial mediation effect, where aging attitudes accounted for 28.20% of the total effect. As shown in Table 4.
Table 3
The mediating effect of aging attitudes on the relationship between social isolation and self-neglect (N = 499)
Equation 1 (with self-neglect as the dependent variable) | Equation 2 (with aging attitudes as the dependent variable) | Equation 3 (with self-neglect as the dependent variable) | ||||
|---|---|---|---|---|---|---|
variant | B | t | B | t | B | t |
a constant (math.) | 15.365 | 23.546 | 65.820 | 46.543 | 24.320 | 16.790 |
Social isolation | -0.273 | -8.256*** | 0.564 | 7.867*** | -0.196 | -5.85*** |
Aging attitudes | -0.136 | -6.852*** | ||||
R2 | 0.168 | 0.172 | 0.240 | |||
F | 24.899*** | 25.601*** | 31.160*** | |||
Table 4
Decomposition of the mediating effect of aging attitudes on the relationship between social isolation and self-neglect (N = 499)
Effect types | Effect | Boot SE | 95%CI | Relative Mediation Effect | |
|---|---|---|---|---|---|
Boot LLCI | Boot ULCI | ||||
Total effect | -0.273 | 0.038 | -0.348 | -0.199 | |
Direct effect | -0.196 | 0.020 | -0.273 | -0.125 | 71.80% |
Indirect effect | -0.077 | 0.015 | -0.109 | -0.050 | 28.20% |
Anzeige
Discussion
This study examined the relationships between social isolation, aging attitudes, and self-neglect among rural older adults living alone in China. The findings indicate that social isolation influences self-neglect both directly and indirectly through the mediating role of aging attitudes. These results offer valuable insights into understanding, preventing, and addressing self-neglect among older adults living alone, particularly in rural settings.
Social isolation’s direct impact on self-neglect
Our study finds an association between greater social isolation and a higher likelihood of self-neglect behaviors, consistent with our hypothesis (H1) and findings by Yu et al. [41], who also identified social isolation as a key factor in urban Beijing. However, their study did not explore the mechanisms underlying this relationship. In contrast, our research adds to this understanding by investigating how aging attitudes may mediate the effect of social isolation on self-neglect. Additionally, our focus on rural older adults in Southwest China provides valuable context, as geographic isolation, limited social networks, and financial constraints may further intensify the impact of social isolation on self-neglect [54]. According to social support theory, individuals’ mental well-being is intricately tied to their social connections. As individuals age, diminished social networks and support may increase susceptibility to depressive symptoms and self-neglect behaviors [55]. Furthermore, social cognitive theory highlights the importance of social interaction in shaping self-perception and social cognition [56]. For rural older adults experiencing social isolation, limited opportunities for meaningful interactions may lead to negative or distorted perceptions about health and aging, which could contribute to self-neglect and further undermine their well-being [33]. Our findings suggest that policy interventions should focus on enhancing community engagement and providing accessible social support. Local social programs, volunteer networks, and improved transportation options may help reduce social isolation and promote overall well-being among older adults living alone in rural areas.
Aging attitudes’ direct impact on self-neglect
Our findings also reveal that negative aging attitudes are significantly associated with more severe self-neglect behaviors, supporting our research hypothesis (H2). This aligns with Tang and Liu’s [33] grounded theory study on self-neglect among rural older adults in China, which suggested that negative aging attitudes—particularly a refusal to accept aging—may directly contribute to self-neglect. Our study further substantiates this by showing that negative aging attitudes not only correlate with self-neglect but may also mediate the relationship between social isolation and self-neglect. Social influence theory posits that societal and cultural factors shape aging attitudes, with stereotypes and negative prejudices often internalized by older adults, potentially reducing their self-esteem [57]. In contrast, the positive aging model suggests that favorable attitudes toward aging can foster a sense of purpose and value, motivating individuals to care for their basic needs [58, 59]. Negative aging attitudes, however, can erode self-identity, fostering feelings of futility, exhaustion, and uselessness [60], which may contribute to self-neglect behaviors. By exploring the role of aging attitudes, our study underscores the importance of promoting positive aging attitudes to help mitigate self-neglect.
Partial mediating effects of aging attitudes in the relationship between social isolation and self-neglect
Interestingly, our study identifies a partial mediating effect of aging attitudes in the relationship between social isolation and self-neglect among rural older adults living alone. This finding suggests that social isolation directly influences self-neglect and indirectly impacts self-neglect through aging attitudes, reinforcing prior findings [34, 61] and supporting our research hypotheses H3 and H4. Our study also refines existing theories, such as social exclusion theory and social cognitive theory, by providing empirical evidence specific to rural older adults living alone. Social exclusion theory posits that reduced social networks and inadequate social support can lead older adults to feel marginalized, useless, or unwanted, fostering negative aging attitudes [62]. This sense of exclusion may be particularly pronounced in rural contexts, where structural and cultural barriers amplify social isolation. Additionally, social isolation also undermines older adults’ self-efficacy, reducing their ability to cope with health challenges and daily life demands, which in turn promotes feelings of helplessness and incompetence [34]. These dynamics align with social cognitive theory, which emphasizes that individuals’ perceptions and attitudes significantly shape their behaviors [56]. Negative aging attitudes, such as disappointment or hopelessness about the future, can lead older adults to deprioritize their health and well-being, culminating in self-neglect behaviors. Our findings suggest that targeted interventions to improve aging attitudes among rural older adults are warranted. Community-based programs and local support groups could play a crucial role in strengthening social networks and fostering positive aging attitudes. Public awareness campaigns addressing ageist stereotypes could further build resilience and challenge negative perceptions of aging. To address the broader impact of social isolation, integrating individual, family, and societal social capital may also be beneficial in enhancing social support and well-being among this population.
Limitation
Our study has several limitations that should be acknowledged.
This study uses a cross-sectional design, which limits its ability to infer causal relationships between social isolation, aging attitudes, and self-neglect. Additionally, it cannot capture dynamic changes over time; for instance, seasonal factors like harsh winters in rural areas may intensify social isolation and influence aging attitudes in ways not reflected in a single time-point measurement. Future longitudinal studies are needed to address these limitations. Moreover, the use of convenience sampling in this study may introduce selection bias, further limiting the generalizability of the findings. To improve the representativeness of future studies, multi-stage stratified random sampling should be considered.
Second, the study relies on self-reported instruments to measure social isolation, aging attitudes, and self-neglect. Although self-reported data have inherent limitations, such as potential recall bias or social desirability bias, we conducted a Harman single-factor test to assess common method bias. The results indicated that common method bias was not a significant concern in our study. Nevertheless, the reliance on self-reported data remains a limitation. Future research should integrate subjective and objective assessment methods, including self-reports, informant ratings, and observational approaches, to complement each other and further enhance the robustness of findings.
Third, although this study controlled for statistically significant demographic variables, such as gender, ethnicity, and self-reported financial condition, it may have overlooked other potential confounders, such as physical health status, cognitive function, and socioeconomic status. Future studies should consider these variables to provide a more comprehensive understanding of these relationships.
Finally, this study focused exclusively on older adults living alone and excluded individuals with severe health conditions or communication impairments. While this exclusion was necessary for ensuring informed consent and voluntary participation, it may have overlooked a particularly vulnerable subgroup, potentially skewing the results. Future research should specifically address the needs and experiences of such vulnerable populations to provide a more inclusive understanding of the issues at hand.
Conclusion
This study offers important insights into the relationship between social isolation, ageing attitudes, and self-neglect behaviours among rural older adults living alone. The findings suggest that both social isolation and ageing attitudes are associated with self-neglect, with ageing attitudes partially mediating this relationship. These results emphasize the importance of fostering positive ageing attitudes to mitigate the impact of social isolation on self-neglect behaviours. While this cross-sectional study cannot establish causality, the findings have practical implications for regions with similar demographic and cultural characteristics. Interventions aiming to reduce social isolation and improve ageing attitudes—such as community engagement initiatives, public awareness campaigns, and support networks tailored to older adults—may help promote healthier ageing and reduce self-neglect. Future research should explore these dynamics longitudinally and across diverse populations to develop targeted strategies that address the interconnected challenges of social isolation and ageing attitudes.
Acknowledgements
We would like to express our sincere gratitude to all the participants and student surveyors who took part in this study.
Declarations
Ethical approval
The study was approved by the Ethics Committee of Guizhou Medical University (approval number: 2022294). All respondents gave informed consent and participated in this study voluntarily.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
