Relationship Between Activities of Daily Living and Attitude Toward Own Aging Among the Elderly in China: A Chain Mediating Model

Abstract

This study used the 2014 China Longitudinal Aging Social Survey to explore the relationship between the activities of daily living, cognitive function, social support, and attitudes toward own aging, and a structural equation model was established to test the mediating effect. (a) Pearson correlations were performed between the total scores on each scale, and the activities of daily living were significantly negatively correlated with cognitive function and social support and significantly positively correlated with attitudes toward own aging. Cognitive function was significantly positively correlated with social support but negatively correlated with attitude toward own aging; social support was significantly negatively correlated with attitude toward own aging. (b) The goodness-of-fit indices of the validation models for each measurement model were robust. The activities of daily living among the elderly can directly predict attitudes toward own aging and can indirectly predict attitudes toward own aging through cognitive function and social support.

Keywords

activities of daily living cognitive function social support attitude toward own aging China elderly

As of the end of 2017, there were 158.31 million elderly people aged 65 years and older in China, who accounted for 11.4% of the total population (National Bureau of Statistics of China). With the increase in the aging population, the health problems of the elderly have attracted the attention of researchers worldwide. The elderly experience numerous challenges, including a decline in the activities of daily living (ADLs), social disengagement, and psychological discomfort, making their beliefs about aging and their evaluations of it more negative (Chachamovich, Fleck, Laidlaw, & Power, 2008; Janecková, Dragomirecká, Holmerová, & Vañková, 2013; Kavirajan et al., 2011; Jim Law, Laidlaw, & Peck, 2010; Trigg, Watts, Jones, Tod, & Elliman, 2012). Negative self-evaluations can reduce the subjective health of older people (Moor, Zimprich, Schmitt, & Kliegel, 2006; Westerhof et al., 2014), thereby affecting healthy lifestyles and preventative behaviors (Levy & Myers, 2004) and even increasing the risk of death (Sargent-Cox, Anstey, & Luszcz, 2014). In recent years, domestic and overseas scholars have increasingly studied successful aging from the perspective of elderly people’s attitudes toward their own aging. Attitudes toward own aging are also known as “self-perceptions of aging,” “aging self-stereotypes,” and “satisfaction with aging” (Jung & Siedlecki, 2018); these refer to cognitive representations and perceptions people have toward their own aging process (Bodner, Ayalon, Avidor, & Palgi, 2017). From the perspective of age stereotypes, attitudes toward own aging represent the connection between the individual’s expectations, experience, and the subjective aging process (Diehl et al., 2014). Many studies have found that attitudes toward own aging are associated with physical outcomes and cognitive functioning, and the extent of one’s attitudes toward own aging can effectively predict mental health and the degree of successful aging among the elderly (Sargent-Cox et al., 2014). Having a positive attitude toward one’s own aging can promote successful aging among the elderly (Baltes & Smith, 2003; Sneed & Whitbourne, 2005).

Attitudes toward one’s own aging are not static over the life course (Bodner et al., 2017). With the increase in age, attitudes on aging of the elderly are affected by internal factors (including health status, cognitive function, and personality characteristics) and external factors (including social environment and social support) (Laidlaw, Power, & Schmidt, 2007; Miche, Elsässer, Schilling, & Wahl, 2014). Therefore, it is of theoretical and practical value to improve attitudes toward own aging among the elderly by changing the relevant factors, and thereby influencing their mental health. The result is indisputable, but the mechanism for determining the influence of these factors remains unclear (Sargent-Cox, Anstey, & Luszcz, 2012).

Physical function directly affects the positive and negative attitudes of the elderly (Laidlaw, Kishita, Shenkin, & Power, 2018). Physical function status can be obtained by assessing the ADLs (Katz, Ford, Moskowitz, Jackson, & Jaffe, 1963). ADLs are divided into two aspects: the basic ADLs (BADLs) and the instrumental ADLs (IADLs); the former mainly involves self-care: bathing and changing clothes; the latter is mainly related to more complex activities such as housework, financial management, and proper medication (Paula et al., 2014). The study found that there is a direct dynamic relationship between self-aging perceptions and physical functions (Sargent-Cox et al., 2012); healthy living behaviors can improve attitudes to aging among the elderly (Yamada, Merz, & Kisvetrova, 2015). Wolff, Warner, Ziegelmann, and Wurm (2014) organized an intervention study of elderly people over the age of 65 years who participated in a 10-month physical activity program and found that their ability to train in a physical activity improved, and their attitude toward their own aging became more positive. A 12-year longitudinal study by Miche et al. (2014) supports this view. It found that the ADLs can directly affect attitudes toward one’s own aging. A positive self-aging attitude depends on the individual’s independent functioning (Kavirajan et al., 2011).

ADLs, Cognitive Functions, and Attitudes Toward Own Aging

Cognitive functions, including perception, memory, attention, thinking, and language are an important part of psychological processes (Curtis, Windsor, & Soubelet, 2015). With age, cognitive functions decline in the elderly owing to reduction in physical functions or changes in the nervous system (Curtis et al., 2015), which in turn leads to increased difficulties in life activities and higher risk of death (Gale et al., 2018; Su et al., 2014), thus making older people more negative in their attitudes toward aging (Gale & Cooper, 2017; Laidlaw et al., 2018). Fauth et al. (2013) found that abilities involved in daily living activities are important factors in changes in cognitive function among the elderly, and those with high ADLs have higher cognitive functions. Njegovan, Hing, Mitchell, and Molnar (2001) used community seniors as the research population and found that progressive cognitive decline in elderly people was related to specific loss of physical functions. Specifically, the loss of physical independence in a particular task resulted in greater cognitive decline for these individuals than for those who remained physically independent. However, older people can reduce the risk of chronic diseases associated with cognitive decline through independent living or improving ADLs (Cotman, Berchtold, & Christie, 2007; Haskell et al., 2007).

Cognitive dysfunction refers to one or more impairments in cognitive functioning and can affect an individual’s ability to remember and learn in daily life (An & Liu, 2016). Cognitive impairment has a negative impact on attitudes toward one’s own aging (Kliegel & Zimprich, 2005). This is consistent with the view of dynamic integration theory (DIT). DIT states decline in physical functions may result in more negative emotions; in contrast to relatively positive emotions, dealing with negative emotions requires greater cognitive functioning in the elderly; moreover, negative emotions are more relevant to cognitive function. That is to say, the decline in cognitive functions associated with aging makes it more difficult for older people to integrate and accept negative emotions (Labouvie-Vief, 2003). This may cause the elderly to have more negative attitudes toward aging.

If attitudes toward one’s own aging are the result of cognitive changes, results of our study can effectively promote the successful aging of middle-aged adults (Miche et al., 2014). Therefore, we hypothesize that cognitive functions may mediate between the ADLs and attitudes toward one’s own aging.

ADLs, Cognitive Functions, Social Support, and Attitudes Toward Own Aging

Social support is the amount of emotional and practical support that individuals receive from their families and friends and is the result of individual social capital (Gray, 2009; Laidlaw, Wang, Coelho, & Power, 2010). The most common sources of social support are families (spouse, children, and siblings), followed by close friends (Campbell, Connidis, & Davies, 1999; Lynch, 1998). The family can provide its members with physical, material, and emotional support to meet various basic needs (food, housing, and personal hygiene), the psychological needs of the individual (self-esteem and emotion), and social needs (identity, communication, and sense of belonging) (Alvarenga, de Campos Oliveira, Domingues, Amendola, & Faccenda, 2011; Gallegos-Carrillo et al., 2009). Compared with family support, support from friends is an “alternative” social interaction (Lee & Shehan, 1989; Litwin, 2001). According to socioemotional selectivity theory, the motivation for interpersonal interaction for the elderly is more focused on the emotional function of communication, and they are more inclined to maintain and promote interaction with others that are important to them (Carstense, Isaacowitz, & Charles, 1999). In other words, the friends chosen by the elderly are those who are most meaningful to them, and the support they receive is often of high quality.

As we age, the decline in our ability to maintain ADLs and cognitive functions (Stevens & Kaplan, 1999) may lead to a rapid decline in various bodily functions and in social interaction (Fauth et al., 2013) as social support networks become increasingly scarce (D. Feng, Ji, & Xu, 2014; Fratiglioni, Paillard-Borg, & Winblad, 2004; Zamora-Macorra et al., 2017). Many studies have found that better cognitive functioning, physical health, and state of mind in later years are closely linked to greater social support (Ellwardt, Aartsen, Deeg, & Steverink, 2013; Lamont, Nelis, Quinn, & Clare, 2016; Zunzunegui et al., 2004). A social network of families and friends helps relieve stress and depression (Bankoff, 1983; Litwin, 2001), which is positive for older people’s physical, emotional, and mental health, as well as their quality of life (Zamora-Macorra et al., 2017). Social support is an important system for maintaining the mental health of the elderly and is closely related to their attitudes toward aging (Rashid, Ong, & Wong, 2012). It can be seen that by strengthening the social support network to improve emotional communication and increase instrumental support, negative aging attitudes may be alleviated (Lamont et al., 2016).

Stereotype Embodiment Theory (Levy, Zonderman, Slade, & Ferrucci, 2009) argues that negative attitudes to aging affect individual psychological, behavioral, and physiological functions in a variety of ways, and that age-related changes are inevitable and irreversible. Individual age stereotypes or attitudes toward older people can begin in early childhood and be internalized as a form of self-concept (Kornadt & Rothermund, 2012; Laidlaw, Kishita, Shenkin, & Power, 2018; Rothermund & Brandtstädter, 2003), thus gradually influencing individual behavior (Sargent-Cox et al., 2014; Siebert, Wahl, & Schröder, 2016). Hattie and Marsh (1996) suggest that important people in life (such as parents, teachers, and peers) have a great influence on the formation of self-concept. The formation of individual self-concept comes from summarizing past experiences and from the reactions and evaluations of others. It can be seen that the support of family and friends in the life of the elderly is an important factor in developing healthy attitudes toward one’s own aging.

There are few studies on the impact of social support networks on individual attitudes toward own aging (Lamont et al., 2016). Inconsistent findings exist regarding the positive impact of older social networks and frequent social contacts on aging attitudes (Kavirajan et al., 2011; Kim, Jang, & Chiriboga, 2012). The causal relationship between cognitive function and social support has not been positively verified (Zamora-Macorra et al., 2017). As far as current research is concerned, few studies have used physical, psychological, and social variables as predictive measures to correlate with attitudes toward own aging (Kavirajan et al., 2011).

This study intends to address the complex mechanisms of daily living activities, cognitive functions, social support, and elderly Chinese people’s attitudes toward own aging. This has important theoretical significance for promoting the mental health of the elderly and their successful aging. This study assumes that the ADLs affect attitudes toward one’s own aging not only directly but also indirectly through cognitive function or social support, which have a chain-mediating effect on the relationship between daily living activities and attitudes toward own aging.

Method

Participants and Procedure

Data were collected by the China Longitudinal Aging Social Survey organized by the Institute of Gerontology, Renmin University of China. The respondents were Chinese citizens aged 60 years or older. The survey covered 29 provinces (autonomous regions/municipalities directly under the Central Government, excluding Hong Kong, Taiwan, Macao, Hainan, Xinjiang, and Tibet) and a total of 462 villages/neighborhood committees. Stratified sampling methods were used in each village/neighborhood to sample households and one elderly person in each household was visited. Finally, the 2014 China Longitudinal Aging Social Survey obtained 11,511 surveys from seniors. Approximately 24.2% of the sample (n = 2,788) was excluded in this study as a result because 2,703 older people in the Attitude Toward Own Aging Scale did not answer, and 85 seniors did not answer in the Mini-Mental State Examination. In this study, 8,723 respondents were obtained after excluding the missing values of key variables (Tang, Lin, & Chen, 2019). Among them, 4,688 (53.7%) were males and 4,035 (46.3%) were females; 5,746 (65.9%) were in urban areas and 2,976 (34.1%) in rural areas; 6,149 (70.5%) were married and 2,564 (29.4%) were single; 5,049(57.9%) were aged 60 to 69 years; 2,667(30.6%) were 70 to 79 years of age; and 1,007 (11.5%) were aged 80 years or older. The average age of the participants was 69.82 years (SD = 7.54).

Measures

Activity of Daily Living Scale

The Activity of Daily Living Scale developed by Lawton and Brody (1969) is divided into the BADLs and the IADLs (Paula et al., 2014). In this study, BADLs include bathing, dressing, going to the toilet, eating, and so on; IADLs include whether an individual can go to a neighbor’s house, wash clothes, cook, and so on, for a total of 13 topics. The answers to each question are divided into response categories: no need for help, need some help, and cannot do it at all, to which 1 to 3 points are assigned, respectively. The higher the score, the worse the elderly person functions in daily life activities. Cronbach’s α coefficient for BADLs was .888 and for IADLs was .814.

Mini-Mental State Examination

The cognitive functions of the elderly were measured using the Mini-Mental State Examination proposed by Folstein, Folstein, and McHugh (1975). The scale, which is commonly used internationally and shows good reliability, includes general functions (five topics), memory functions (three topics), attention and calculation functions (five topics), and recall functions (three topics) for a total of 16 topics (L. Feng et al., 2014; Folstein et al., 1975), Each subquestion scored 0 points and the correct answer scored 1 point; the higher the total score, the stronger the cognitive function. Cronbach’s α for this scale was .679.

Social Network Scale

Social support for the elderly is measured using the Social Network Scale (Lubben et al., 2006). In this study, the scale consists of six items, which are graded according to the number of relatives and friends who can help the elderly person. indicator; the higher the score, the higher the level of social support found. In this study, the Cronbach’s α coefficient of the scale was .782.

Attitude Toward Own Aging Scale

The Attitudes to Aging Questionnaire was used to measure attitudes toward own aging among the elderly (Yi-fan, Da-hua, Yong-guang, & Laidlaw, 2010). Participants indicated their degree of agreement to four items, including “I feel old,” “Old age mainly as a time of loss,” “More difficult to make new friends,” and “Feel excluded from things because of my age.” In the current sample, the questionnaire was assessed on a 5-point Likert-type scale: The higher the score, the more negative the attitude toward own aging. The Cronbach’s α coefficient of the attitude toward own aging in this study was .674.

Results

Common Method Bias Control

Because all of the data came from self-reporting by the elderly, results were likely to produce a common method bias that reduced research validity. Approaches for controlling for common method bias include “process control” and “statistical control.” Process control refers to control measures incorporated into the process of a study’s design and measurement. The questionnaires in this study were only used for academic purposes, and participants’ information was kept strictly confidential. Each of these methods has been shown to control common method bias. Statistical control involves a statistical test that is applied after data collection. In this study, the Harman single factor test was used to test the common method bias of the study (Yao & Yang, 2017). The results showed that eight factors were obtained after both rotation and no rotation. The first factor obtained after nonrotation and rotation explained the variance of 19.37% and 12.93% (both less than 40%), indicating that there is no common method bias in this study.

Initial Analyses

To explore the relationship between ADLs, cognitive functions, social support, and attitudes toward own aging, Pearson correlation analyses were examined. The results are shown in Table 1. Attitude toward own aging was significantly negatively correlated with cognitive function and social support. There was a significant positive correlation between attitude toward own aging and ADLs.

Table 1.
Pearson’s Correlations Among Main Variables.

M ± SD 1 2 3 4

1. ADLs 14.05 ± 2.66 1

2. Cognitive function 13.36 ± 2.59 −0.245 1

3. Social support 15.11 ± 6.44 −0.120 0.136 1

4. Attitude toward own aging 12.84 ± 3.84 0.201 −0.221 −0.207 1

Note. N = 8,723. ADLs = activities of daily living.

**
Difference is significant at .01 level.

Construction of Chain Mediation Model

The collinearity diagnostics showed that tolerances (0.932, 0.928, and 0.974) were greater than 0.10, and the variance inflation factors (1.073, 1.077, and 1.027) were less than 10. Therefore, no serious collinearity problem was indicated.

To further examine the relationship between the ADLs and cognitive function, social support, and attitude toward own aging, and to test the mediating role of cognitive function and social support, a latent variable structure model was used to construct the relationship model between the four variables. In the structural equation model, ADLs were used as the predictor, and attitude toward own aging was the outcome variable; cognitive function and social support were established as the latent variable model.

The results show that the model has a good fit index: χ²/df = 17.62, root mean square error of approximation = 0.044, comparative fit index = 0.972, Tucker–Lewis index = 0.949. All regression weights of all paths are provided, including standardized βs, unstandardized βs, standard errors, and p values (Table 2).

Table 2.
Results of Variables’ Regression Weights.

Unstandardized coefficients
Standardized coefficients
Significance

β1 SE β2

Cognitive function ← ADLs −0.239 0.010 −0.245 0.000

Attitude toward own aging ← ADLs −0.290 0.015 −0.201 0.000

Attitude toward own aging ← Cognitive function −0.328 0.015 −0.222 0.000

Social support ← ADLs −0.290 0.026 −0.120 0.000

Social support ← Cognitive function 0.339 0.026 0.136 0.000

Attitude toward own aging ← Social support −0.123 0.006 −0.207 0.000

Note. ADLs = activities of daily living.

Analysis of the path in the model (Figure 1) shows that the ADLs have a significant negative predictive effect on cognitive function (β = −0.287, p < .001) and a significant positive predictive effect on attitude toward own aging (β = 0.183, p < .001); cognitive function has a significant negative predictive effect on attitude toward own aging (β = −0.355, p < .001), suggesting that it plays a partial mediating role in ADLs and attitude toward own aging. In addition, the ADLs have a significant negative predictive effect on social support (β = −0.092, p < .001), and cognitive function has a significant positive predictive effect on social support (β = 0.154, p < .001), indicating that the latter plays a part in mediating the relationship between ADLs and social support. Social support has a significant negative predictive effect on attitude toward own aging (β = −0.310, p < .001). Therefore, it plays a partial mediating role in the ADLs and attitude toward own aging.

Figure 1.
Chain-mediated model diagram of ADLs and attitude toward own aging.

Mediation Effects Test

In this study, the bootstrap analysis method was used to test whether the mediation effect was significant in 2,000 samples, and the confidence interval was set at 95%. If the 95% confidence interval of the path coefficient did not include 0, the mediation effect was significant. The mediating effect of cognitive function between ADLs and attitude toward own aging was ab = 0.102 [0.086, 0.120]; the mediating effect of social support between ADLs and attitude toward own aging was ab = 0.029 [0.021, 0.039]; the mediating effect of cognitive function and social support between ADLs and attitude toward own aging was ab = 0.014 [0.009, 0.019], where confidence intervals did not contain 0. Therefore, each path coefficient is again significant. The direct effect from ADLs to attitude toward own aging is 0.183; the total indirect effect—the sum of the total mediational effects of all paths—is 0.144 (Wen, Zhang, Hau, & Liu, 2004); the total effect—the sum of the direct effect and total indirect effect—is 0.327. Effect size for the indirect effect divided by the total effect, the indirect path through cognitive function has an effect size of 31.19%; the indirect path through social support has an effect size of 8.87%; and the indirect path through cognitive function and social support has an effect size of 4.28%.The total indirect effects size was 44.04%.

Discussion

The present analysis of data for 7,686 elderly people in China reveals the influence of ADLs on attitude toward own aging, as well as the mediating role of cognitive function and social support. Correlation analysis shows that the ADLs of the elderly are positively correlated with their attitudes toward own aging; although the correlation coefficient is weak, this is consistent with many previous studies (Bodner et al., 2017; Kavirajan et al., 2011; Sargent-Cox et al., 2012, 2014). Older people with poor ADLs have a negative attitude toward their own aging, which engenders a poor experience and evaluation of their aging process, and may produce negative emotional experiences. They are more likely to avoid problems related to bodily aging and avoid physical exercise, which in turn makes them less active. That is, the older the elderly are and the lower their ability to perform activities, the more negative their attitudes are toward their own aging, which could be the beginning of a vicious cycle.

In addition, this study found that the ADLs can influence attitudes toward own aging indirectly through cognitive function; that is, cognitive function plays a part in mediating the relationship between ADLs and attitudes toward own aging. This result supports the theory of dynamic integration to a certain extent. When the elderly are engaged in low levels of daily living activities, it is difficult to live independently, because they are unable to complete basic or slightly complicated instrumental tasks, which may result in further negative emotions. According to the DIT, dealing with negative emotions requires greater cognitive functions on the part of the elderly (Labouvie-Vief, Diehl, Jain, & Zhang, 2007). As individuals age, ADLs and cognitive functions show a downward trend, and the elderly limit themselves to a narrower range of physical and social environments (Labouvie-Vief, 2003). In the context of limited cognitive resources, the elderly are unable to actively respond to the negative experiences brought about by the decline in daily living activities, which impacts the adjustment ability of the elderly and results in negative emotions, likely causing the elderly to have more negative attitudes toward aging.

Furthermore, we found that the ADLs can indirectly affect attitudes toward own aging and social support. This result also supports the Stereotype Embodiment Theory to a certain extent. The theory holds that individual attitudes toward older people can begin in early childhood and be internalized as a form of self-concept (Levy et al., 2009). The formation of individual self-concept derives from the summation of past experiences and from the reactions and evaluations of others. The support of families and friends in the lives of older people will have had varying degrees of influence on their attitudes toward their own aging. The ADLs are positively correlated with attitudes toward own aging and have a positive predictive effect on attitudes toward own aging. It can be seen that when the elderly engage in low levels of ADLs, they require more care from the family or the society. If these are unsatisfactory, the elderly will be trapped in negative emotions, which can lead to further denial of themselves. However, timely support from families or friends can meet the needs of older people and improve their life satisfaction.

Notably, the results of this study show that cognitive functioning and social support are involved in a chain of multiple mediating roles in the relationship between ADLs and attitudes toward own aging. From the perspective of the chain mediation model, the indirect path through cognitive function and social support has an effect size of 4.28%; there is no denying that this may have resulted from a large sample size. However, the total amount of indirect effect size of 44.04% is acceptable.

With age, the attitudes of the elderly are increasingly influenced by internal factors (health, cognitive function, etc.) and external factors (social support, etc.) (Laidlaw et al., 2007; Miche et al., 2014). According to the theory of dynamic integration, as age increases, and the ADLs and cognitive functions decrease, negative emotions increase accordingly. It is highly likely that these will involve poor evaluations of themselves, their families, and society. However, the Stereotype Embodiment Theory suggests that individual age stereotypes or attitudes toward the elderly are related to self-concept, and the formation of self-concepts is related to the important people (families and friends) in one’s life. Therefore, if the elderly can obtain timely support when they experience difficulties in daily life, their attitudes toward their own aging can easily become more positive.

The findings of this study expand the research field of ADLs and attitudes to aging; explore the relationships between ADLs, cognitive function, social support, and attitudes toward own aging among the elderly; reveal the mechanisms linking these activities; and enrich the relevant research. It is well known that age-related AD is a degenerative disease that causes a severe decline in cognitive and behavioral functions and has become one of the most feared diseases among the elderly (Kessler, Bowen, Baer, Froelich, & Wahl, 2012). Negative attitudes toward one’s own aging are also a risk factor for cognitive impairment in the elderly (Siebert, Wahl, Degen, & Schröder, 2018). In elderly communities, AD diagnostic screening, IADLs, and the Mini-Mental State Examination are commonly used screening tools (Koskas et al., 2014; Sikkes et al., 2011). The condition of IADLs and cognitive function can effectively predict cognitive impairment in the elderly. Therefore, the results of this study can provide a useful reference for the successful aging of the elderly by recommending that they pay attention to physical exercise, cognitive training in daily life, rational and effective use of resources, and effectively enhancing their attitudes toward their own aging. Service requirements and standards can also be provided for caregivers. The quality of care should rely on achieving three levels of satisfaction: physical, psychological, and social. We also found that elderly people’s attitude toward their own aging, especially successful aging, is influenced by internal and external physical, psychological, and social factors. This study examined only three factors as it is difficult to effectively examine the operative internal mechanisms; this dimension requires further research. This study is essentially a relational study and cannot prove causality. Subsequent research should be supplemented by longitudinal research to improve the external validity of the study, and as the use of large samples may generate data error that also needs to be verified. Future studies should additionally focus on the impact of cultural context on attitudes toward aging.

Conclusion

The ADLs among the elderly can directly predict attitudes toward own aging, as well as indirectly through the mediating variables of cognitive function and social support. Cognitive function and social support can also play a role in linked mediation; the ADLs negatively predict cognitive function, cognitive function positively predicts social support, and inversely predicts attitudes toward own aging.

	M ± SD	1	2	3	4
1. ADLs	14.05 ± 2.66	1
2. Cognitive function	13.36 ± 2.59	−0.245**	1
3. Social support	15.11 ± 6.44	−0.120**	0.136**	1
4. Attitude toward own aging	12.84 ± 3.84	0.201**	−0.221**	−0.207**	1

	Unstandardized coefficients	Standardized coefficients	Significance
Cognitive function ← ADLs	−0.239	0.010	−0.245
Attitude toward own aging ← ADLs	−0.290	0.015	−0.201
Attitude toward own aging ← Cognitive function	−0.328	0.015	−0.222
Social support ← ADLs	−0.290	0.026	−0.120
Social support ← Cognitive function	0.339	0.026	0.136
Attitude toward own aging ← Social support	−0.123	0.006	−0.207

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Major Projects of the Key Research Base of Humanities and Social Sciences of the Ministry of Education: Status Quo of Mental Health of the Aged in the Process of Aging Society and Countermeasures (15JJD190004). Data collection for this study was supported by the China Longitudinal Aging Social Survey organized by the Institute of Gerontology, Renmin University of China.

Author Biographies

Gang Wang, Nanjing Normal University, PhD candidate, Institute of Elderly Management, Jiangsu Vocational Institute Of Commerce, Assistant Professor. Current research area is psychology for the elderly.

Juan Shi, Nanjing Normal University, PhD Candidate. Current research area is general psychology.

Jin Yao, Nanjing Normal University, PhD Candidate. Current research area is psychology for the elderly.

Hong Fu, Correspondent Author, Nanjing Normal University, Professor. Current research area is applied psychology.

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