Living alone, social cohesion, and quality of life among older adults in rural and urban China: a conditional process analysis

<jats:title>ABSTRACT</jats:title><jats:sec id="S1041610220001210_as1"><jats:title>Objectives:</jats:title><jats:p>To test the independent and combined impact of social cohesion and geographic locale (urban/rural) on quality of life (QoL) for older adults in China. Using conditional process analysis, we tested three hypotheses: (1) QoL will be lower for persons living alone than those who live with family; (2) social cohesion will mediate the association of living arrangement and QoL; and (3) geographic locale will moderate direct and indirect pathways in the mediation model.</jats:p></jats:sec><jats:sec id="S1041610220001210_as2"><jats:title>Design:</jats:title><jats:p>Cross-sectional data from WHO Study on Global Aging and Adult Health (SAGE) (China, Wave 1, 2007–2010).</jats:p></jats:sec><jats:sec id="S1041610220001210_as3"><jats:title>Setting:</jats:title><jats:p>National probability sample of 74 primary sampling units in China, 32 in urban, and 32 in rural areas.</jats:p></jats:sec><jats:sec id="S1041610220001210_as4"><jats:title>Participants:</jats:title><jats:p>A total of 9,663 adults aged 50 years and older.</jats:p></jats:sec><jats:sec id="S1041610220001210_as5"><jats:title>Measurements:</jats:title><jats:p>We measured QOL with the 8-item version of the WHOQOL-Bref; living arrangement as alone versus with family; and social cohesion with an 9-item index of frequency of a range of social activities in the previous 12 months. We controlled for sociodemographic characteristics and health and mental health variables in multivariate analyses.</jats:p></jats:sec><jats:sec id="S1041610220001210_as6"><jats:title>Results:</jats:title><jats:p>Data supported the first two hypotheses; however, the mediating effects of social cohesion held only in urban areas.</jats:p></jats:sec><jats:sec id="S1041610220001210_as7"><jats:title>Conclusion:</jats:title><jats:p>This study advances the large body of work on living arrangements and well-being of older adults in China. Social cohesion contributed to better QoL regardless of living arrangement, and cohesion mediated the association of living arrangement and QOL in urban but not rural areas. Programs and policies that strengthen social cohesion through older adults’ community involvement, especially in urban areas, will help to enhance QoL.</jats:p></jats:sec>