| Objective To investigate the current prevalence of social isolation among the elderly with chronic diseases,to investigate the influencing factors of social isolation among the elderly with chronic diseases,and to analyze the pathways between aging attitudes,intergenerational support,and social isolation among the elderly with chronic diseases;to examine the impact of the interaction between aging attitudes and intergenerational support on social isolation while controlling for confounding variables.Method In this study,a cross-sectional study design was adopted.320 elderly with chronic diseases,60 years of age or older,from four towns in Hefei,Anhui Province,were chosen for the study between July and August 2022 using stratified whole-group intact sampling.The Social Network Scale(LSNS-6),Intergenerational Support Scale,Aging Attitude Questionnaire,Activities of Daily Living Ability Scale,and Simple Mental Status Scale were used to evaluate the social isolation,intergenerational support,aging attitude,activities of daily living ability,and cognitive function levels of the study subjects.A self-designed general information questionnaire was used to collect socio-demographic and disease-related information about the study subjects.The database was created and data entered using Epidata 3.1,and data collection and statistical analysis were performed using SPSS 26.0.The current condition and factors influencing the prevalence of social isolation among the chronically ill elderly were examined using the t-test,ANOVA,and multiple logistic regression analysis.Pearson correlation analysis was used to examine the relationships between intergenerational support,daily living activities ability,attitudes toward aging,and social isolation,and structural equation models for the four were constructed using Amos 23.0,and the mediating effects were tested using the Bootstrap method with 2000 replicate samples.The effect of the interaction of intergenerational support and aging attitudes on the occurrence of social isolation among the elderly with chronic diseases was studied using a chi-square test,binary logistic regression,and the strength of the interaction association was expressed as OR values.The additive interaction of intergenerational support and aging attitudes on the prevalence of social isolation in older adults with chronic conditions was tested using the risk of interaction(RERI),the attributable proportion due to interaction(AP),and the synergy score(S).The effect of the additive interplay of intergenerational support and aging attitudes on the social isolation of older individuals with chronic conditions was examined using the synergy index(S).Results(1)Among 531 elderly with chronic diseases,32.8%(n=174)had poor intergenerational support,37.3%(n=198)had negative attitudes toward aging,38.6%had social isolation(12.44 ± 4.74),32.2% had family isolation(6.41 ± 2.97),and33.1% had friend isolation(6.02 ± 3.18).(2)The results of the univariate analysis revealed statistically significant differences in the effects of various health self-assessments,comorbid conditions,history of hospitalization in the previous six months,ability to perform daily living activities,cognitive function,sedentary time,living arrangement,intergenerational care status,type of residence,re-employment status,status of recreational organizations in the community,intergenerational support,and aging attitude.(P<0.1).(3)According to the results of binary logistic regression analysis,living in a rural area,having a worsening perception of one’s own health,having difficulty performing activities of daily living,having inadequate intergenerational support,and having negative attitudes toward aging were all risk factors for social isolation in older people with chronic illnesses,while spending more than four hours sitting down was protective(all P<0.05).(4)Intergenerational support scores were positively correlated with aging attitude scores(r=0.413,P<0.05)and negatively correlated with ADL scores(r=-0.294,P<0.05),according to a Pearson correlation analysis.Social isolation scores were negatively correlated with ADL scores(r=-0.368,P<0.05)and positively correlated with both intergenerational support and aging attitude scores(r=0.480,P<0.05).(5)The results of the structural equation model revealed that there were four path routes and that the total effect of intergenerational support on social isolation was 0.866:(1)Intergenerational support can directly affect social isolation among the elderly with chronic diseases,with a direct effect of 0.570,accounting for 65.82% of the total effect [(0.570/0.866)*100%];(2)Intergenerational support can indirectly affect social isolation among the elderly with chronic disease through partial mediation of the ability to perform activities of daily living,with an indirect effect of 0.085,accounting for 9.82% of the total effect[(0.085/0.866)*100%];(3)Through a partially mediated effect of aging attitudes,intergenerational support can indirectly improve social isolation among the elderly with chronic diseases,with an indirect effect of 0.160,accounting for 18.48% of the overall effect [(0.160/0.866)*100%];(4)Through the chain mediating effects of activities of daily living capacity and attitudes toward aging,intergenerational assistance can indirectly increase social isolation among the elderly with chronic diseases,with an indirect effect of 0.051 accounting for 5.89% of the overall effect[(0.051/0.866)*100%].(6)The interaction results revealed that the OR for social isolation in the intergenerational supportive × aging attitude was 1.751(P(29)0.05),the OR for social isolation in the intergenerational good negative aging group was 1.401(P(29)0.05),the OR for social isolation in the intergenerational bad positive aging group was 2.735(P<0.05),and the OR for social isolation in the adverse intergenerational-negative aging group was 6.709(P<0.05).The RERI,AP,and S were calculated to be 3.573(95%CI: 0.187-6.960),0.533(95%CI: 0.239-0.826),and2.673(95%CI: 1.142-6.259),respectively,indicating that there was no multiplicative but an additive interaction between intergenerational support and aging attitudes on the occurrence of social isolation.The OR for family isolation in the intergenerational supportive × aging attitude was 3.548(P=0.006),the OR for 1.056(P(29)0.05),the OR for family isolation in the intergenerational good negative aging group was 0.544(P(29)0.05),and the OR for family isolation in the intergenerational bad positive aging group was 5.786(P<0.05).RERI,AP and S were 4.186(95%CI: 1.449-6.923),0.723(95%CI: 0.528-0.919)and 7.974(95%CI: 1.345-47.268),respectively,indicating a multiplicative and additive interaction between intergenerational support and aging attitudes on the occurrence of family isolation.The OR for friend isolation in the intergenerational supportive × aging attitude was 2.245(P(29)0.05),friend isolation in the intergenerational good negative aging group was associated with an OR of 0.946(P(29)0.05),friend isolation in the intergenerational bad positive aging group was associated with an OR of 2.591(P<0.05),and friend isolation in the intergenerational bad negative aging group was associated with an OR of 5.505(P<0.05).The RERI,AP,and S were calculated to be 2.968(95%CI: 0.220-5.716),0.539(95%CI:0.232-0.846),and 2.930(95%CI: 1.055-8.137),respectively,indicating no multiplicative but additive interaction between intergenerational support and aging attitudes on the occurrence of friend isolation.Conclusion(1)Elderly people with chronic diseases are more likely to experience social isolation,and friend isolation is more common than family isolation.(2)Social isolation in older persons with chronic illnesses was significantly influenced by residence type,health self-assessment,ADL,sedentary hours,aging attitudes,and intergenerational support.(3)Intergenerational support can have an indirect effect on the social isolation among the elderly with chronic diseases through the partially mediated effects of ADL and aging attitudes,and can also affect the social isolation among the elderly with chronic diseases through the chain-mediated effects of ADL and aging attitudes.(4)Intergenerational support and aging attitudes had additive interactions on social isolation among the elderly with chronic diseases,and the additive interaction of the two had a significant effect on social isolation. |
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