Perceived autonomy, family cohesion, and loneliness among community-dwelling older adults in China: a cross-sectional study
- 1Nursing Department, the Second Affiliated Hospital of Zhejiang University School of Medicine
Abstract
Background: Loneliness is a significant public health concern among older adults and is associated with various adverse physical and psychological outcomes. Self-determination theory suggests that autonomy satisfaction may coexist with more voluntary engagement and emotional connectedness in family relationships. Few studies have examined the association between autonomy, family cohesion, and loneliness among Chinese community-dwelling older adults.
Objective: This study examined the direct association between perceived autonomy and loneliness and the indirect association through family cohesion among community-dwelling older adults in China.
Methods: A cross-sectional study was conducted among community-dwelling older adults in China. Data were collected using self-report questionnaires, including the Chinese version of the Perceived Autonomy Scale, the Family Adaptability and Cohesion Evaluation Scales II, and the UCLA Loneliness Scale. PROCESS Macro (model 4) for SPSS was used to examine the indirect association between perceived autonomy and loneliness through family cohesion while adjusting for covariates. The significance of the indirect association was tested using 5,000 bootstrap resamples with 95% confidence intervals.
Results: Data from 447 community-dwelling older adults [age 75.24 ± 7.06 (range: 65-96) years] were analyzed. Perceived autonomy was positively correlated with family cohesion (r = 0.194, p < 0.001) and negatively correlated with loneliness (r = -0.369, p < 0.001); family cohesion was negatively correlated with loneliness (r = -0.373, p < 0.001). After controlling for the covariates, perceived autonomy was positively associated with family cohesion (B = 0.204, 95% CI [0.067, 0.342]), whereas perceived autonomy (B = -0.168, 95% CI [-0.218, -0.118]) and family cohesion (B = -0.094, 95% CI [-0.128, -0.060]) were negatively associated with loneliness. A significant indirect association between perceived autonomy and loneliness through family cohesion was observed (B = -0.019, BootSE = 0.008, 95% bootstrap CI [-0.036, -0.005]), accounting for approximately 10.26% of the total association.
Conclusion: Among community-dwelling older adults in China, higher perceived autonomy was associated with lower loneliness, and a significant indirect association through family cohesion was observed. These findings suggest that perceived autonomy and family cohesion may be important correlates of psychological well-being and loneliness in later life. However, cross-sectional design limited the establishment of causality. Longitudinal and intervention studies are needed to determine whether approaches supporting older adults’ autonomy and family relationships are associated with subsequent changes in loneliness.
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BibTeX
@article{hua2026perceived,
title = {{Perceived autonomy, family cohesion, and loneliness among community-dwelling older adults in China: a cross-sectional study}},
author = {Jing Hua and Yuping Zhang and Yuanyuan Chen and Yanjie Liu and Jingfen Jin},
journal = {Frontiers in Psychiatry},
year = {2026},
month = oct,
doi = {10.3389/fpsyt.2026.1948241},
url = {https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1948241/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Perceived autonomy, family cohesion, and loneliness among community-dwelling older adults in China: a cross-sectional study
AU - Jing Hua
AU - Yuping Zhang
AU - Yuanyuan Chen
AU - Yanjie Liu
AU - Jingfen Jin
PY - 2026
DA - 2026/10/13
JO - Frontiers in Psychiatry
DO - 10.3389/fpsyt.2026.1948241
UR - https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1948241/full
AB - Background: Loneliness is a significant public health concern among older adults and is associated with various adverse physical and psychological outcomes. Self-determination theory suggests that autonomy satisfaction may coexist with more voluntary engagement and emotional connectedness in family relationships. Few studies have examined the association between autonomy, family cohesion, and loneliness among Chinese community-dwelling older adults. Objective: This study examined the direct association between perceived autonomy and loneliness and the indirect association through family cohesion among community-dwelling older adults in China. Methods: A cross-sectional study was conducted among community-dwelling older adults in China. Data were collected using self-report questionnaires, including the Chinese version of the Perceived Autonomy Scale, the Family Adaptability and Cohesion Evaluation Scales II, and the UCLA Loneliness Scale. PROCESS Macro (model 4) for SPSS was used to examine the indirect association between perceived autonomy and loneliness through family cohesion while adjusting for covariates. The significance of the indirect association was tested using 5,000 bootstrap resamples with 95% confidence intervals. Results: Data from 447 community-dwelling older adults [age 75.24 ± 7.06 (range: 65-96) years] were analyzed. Perceived autonomy was positively correlated with family cohesion (r = 0.194, p < 0.001) and negatively correlated with loneliness (r = -0.369, p < 0.001); family cohesion was negatively correlated with loneliness (r = -0.373, p < 0.001). After controlling for the covariates, perceived autonomy was positively associated with family cohesion (B = 0.204, 95% CI [0.067, 0.342]), whereas perceived autonomy (B = -0.168, 95% CI [-0.218, -0.118]) and family cohesion (B = -0.094, 95% CI [-0.128, -0.060]) were negatively associated with loneliness. A significant indirect association between perceived autonomy and loneliness through family cohesion was observed (B = -0.019, BootSE = 0.008, 95% bootstrap CI [-0.036, -0.005]), accounting for approximately 10.26% of the total association. Conclusion: Among community-dwelling older adults in China, higher perceived autonomy was associated with lower loneliness, and a significant indirect association through family cohesion was observed. These findings suggest that perceived autonomy and family cohesion may be important correlates of psychological well-being and loneliness in later life. However, cross-sectional design limited the establishment of causality. Longitudinal and intervention studies are needed to determine whether approaches supporting older adults’ autonomy and family relationships are associated with subsequent changes in loneliness.
SN - 1664-0640
ER -