The Longitudinal Association Between Disability and Loneliness Among Older Adults in China: An Urban–Rural Comparative Analysis

Abstract

Loneliness is a major mental health concern among older adults and has been increasingly linked to functional decline in later life. This study aimed to inform targeted care strategies by exploring urban–rural differences in the longitudinal association between disability and loneliness among older adults in China. Data were obtained from 6654 adults aged 60 and older across three waves (2016, 2018, 2020) of the China Longitudinal Aging Social Survey (CLASS). Disability was measured with Activities of Daily Living (ADL) scale, and loneliness was measured with self-report items. Cross-lagged panel models (CLPMs) were constructed separately to examine the longitudinal associations for urban and rural older adults. Rural older adults reported higher levels of loneliness than urban older adults, and older women reported higher levels of loneliness than older men. Loneliness predicted increased disability at subsequent waves in urban and rural older adults. Disability predicted increased loneliness at subsequent waves only among rural older adults, not among urban older adults. Disability and loneliness were longitudinally associated among older adults in China, with notable urban–rural differences. Integrated physical and psychological interventions are critical in rural areas, whereas strategies should prioritize early loneliness screening to prevent subsequent functional decline in urban areas.