Social isolation and falls among older adults in China: the mediating roles of depressive symptoms and cognitive function

Objectives This study aimed to investigate how depressive symptoms and cognitive function mediate the bidirectional relationship between social isolation and falls among older adults in China.Methods The data were derived from the 2013, 2015, and 2018 waves of China Health and Retirement Longitudinal Study. The analytic sample comprised 6,338 respondents aged 60 years and older. Longitudinal cross-lagged models were built to test the proposed mediation model.Results Depressive symptoms bidirectionally mediated the relationship between 2013 subjective isolation and 2018 fall (indirect effect = 0.003, SE = 0.001, p < .05), as well as that between 2013 fall and 2018 subjective isolation (indirect effect = 0.005, SE = 0.002, p < .01). Cognitive function mediated the association between 2013 objective social isolation and 2018 fall (indirect effect = 0.002, SE = 0.001, p < .05).Conclusion This study highlights the complex bidirectional mechanisms between social isolation and fall, revealing that depressive symptoms and cognitive function serve as distinct mediators in this relationship. Future research and practices should address both social isolation and the underlying psychological and physiological mechanisms to reduce fall risk in older adults.