Factors associated with social integration among Chinese older adults with physical disability: a socio-ecological perspective

Social integration is crucial for the well-being among older adults with physical disabilities, yet evidence on its associated factors across socio-ecological levels in China remains limited. To examine social integration and its associated factors among Chinese older adults with physical disability within the socio-ecological model (SEM). A cross-sectional study recruited 520 community-dwelling older adults with physical disability, using convenience sampling at outpatient rehabilitation clinics in three hospitals between September and December 2024. Data were collected using the Social Integration in Later Life Scale for social integration, Barthel Index for severity of physical disability, Perceived Social Support Scale for perceived social support, and Leyden Walking Instrument for perceived community walkability. Pearson correlations​ and multiple linear regression were performed. The mean SILLS total score was 53.66 ± 12.54. In the fully adjusted model (adjusted R² = 0.589), older age at the micro-level was negatively associated with social integration ( B = − 0.248, P < 0.001). At the meso-level, perceived social support was positively associated with social integration ( B = 0.438, P < 0.001), while perceived community walkability showed an overall association ( F (10, 488) = 7.282, P < 0.001), although this association was not statistically significant in a restricted sensitivity analysis ( n = 200, P = 0.119). At the macro-level, pension insurance enrollment was positively associated with social integration ( B = 3.727, P < 0.001). These findings may inform the development of multilevel interventions aimed at enhancing social integration and promoting health among older adults with physical disability.