Association between loneliness and self-care in elderly individuals with chronic kidney disease: a structural equation modeling approach.

BACKGROUND: Chronic kidney disease (CKD) presents a growing global challenge among aging populations. Effective self-care remains a cornerstone of disease management in elderly patients. This study investigated the association between loneliness and self-care behaviors, including basic and instrumental activities of daily living (ADLs), in elderly individuals with CKD attending selected educational and medical centers affiliated with Tabriz University of Medical Sciences. METHODS: In this descriptive-analytical study conducted in 2022, 310 elderly individuals diagnosed with CKD were assessed using validated instruments: the Chronic Kidney Disease Self-Care (CKDSC) questionnaire, basic and instrumental ADL scales, and a standardized loneliness measure. Structural equation modeling using AMOS software was employed to evaluate model fit and estimate the predictive value of loneliness on variance in self-care. RESULTS: The proposed model demonstrated acceptable fit indices (p < 0.001; root mean square error of approximation, RMSEA = 0.072; comparative fit index, CFI = 0.995; goodness-of-fit index, GFI = 0.994). The final model accounted for 83% of the variance in self-care. Loneliness exerted the most substantial effect on self-care behaviors (β = 1.29, 95% CI [1.17, 1.41]; p < 0.001). CONCLUSION: Findings indicate that loneliness may unexpectedly enhance self-care engagement among elderly individuals with CKD. These results underscore the importance of context-specific interventions that address the complex psychological dynamics influencing self-management. Future longitudinal studies are warranted to explore the mediating pathways underlying this association.