Path ways of two-way social support, resilience, and sense of coherence in relation to health-related quality of life among community-dwelling older adults: a study based on salutogenic theory.

OBJECTIVE: From the perspective of salutogenesis, this study aimed to explore the influencing pathways of two-way social support, psychological resilience, and sense of coherence on health-related quality of life (HRQOL) among community-dwelling older adults. BACKGROUND: With the rapid progression of population aging, the health-related quality of life (HRQOL) of the older adults has become increasingly significant, serving as a crucial consideration in national health promotion efforts and the formulation and evaluation of public health policies. METHODS: A cross-sectional study was conducted using a convenience sampling to recruit 920 community-dwelling older adults from three districts of a city in Hubei Province between April and June 2025. Data were collected using a general information questionnaire, the Sense of Coherence Scale, the Two-Way Social Support Scale, the Brief Resilience Scale, and the SF-12 Health Survey. Descriptive statistics, structural equation modeling, and Bootstrap mediation effect tests were conducted using SPSS 26.0 and AMOS 23.0. RESULTS: The scores for physical component summary (PCS) and mental component summary (MCS) of HRQOL among the older adults were (62.93±19.001) and (70.82±17.781), respectively. Statistically significant differences in PCS and MCS scores were observed among older adults with varying marital status, educational level, medical insurance type, frequency of physical exercise, sleep quality, regularity of three meals a day, and number of chronic diseases. Additionally, statistically significant differences in PCS scores were noted among older adults with different genders, age groups, per capita monthly income, and alcohol consumption status (P< 0.05). Two-way social support had a direct positive predictive effect on both PCS (β= 0.113, P = 0.011) and MCS (β=0.270, P=0.009). It also exerted indirect effects through the independent mediation of psychological resilience and sense of coherence, as well as through the chain mediation pathway composed of these two factors. The chain mediation effects accounted for 17.16% (PCS) and 13.68% (MCS) of the total effects, respectively. CONCLUSION: HRQOL among community-dwelling older adults is jointly influenced by two-way social support, psychological resilience, and sense of coherence, with psychological resilience and sense of coherence playing a chain-mediating role between two-way social support and HRQOL. It is recommended that efforts be made to improve the social support system while also emphasizing the cultivation of psychological resources among the older adults to enhance their health-related quality of life.