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

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. 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. 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). 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.