Objective To understand the influence of activities of daily living (ADL) on feelings of uselessness among older adults in China, and the role of attitudes toward aging and age on this relationship, to provide a reference for developing health education and intervention strategies for older adults, and to effectively address the challenges of population aging.

Methods Study data on 10 883 residents aged 60–98 years were collected from a wave of the China Longitudinal Aging Social Survey (CLASS) conducted in 2020 in 28 provincial-level administrative divisions across China in 2020. A moderated mediation model was used to analyze the relationships among ADL, attitudes toward aging , age, and feelings of uselessness. Statistical analysis and moderated mediation effect tests were conducted using SPSS 26.0 and its PROCESS 4.1 plug-in (Model 5).

Results For all the participants with a mean age of 71.5±6.6 years, the number (percentage) of individuals who reported feeling useless often, sometimes, and never were 1 729 (15.89%), 4 582 (42.10%), and 4 572 (42.0%), and the mean scores for feelings of uselessness, ADL, and attitudes toward aging were 0.739±0.715, 0.238±1.075, and 14.311±3.638, respectively. Correlation analysis showed that the mean score of feelings of uselessness was positively correlated with the mean scores of ADL (r=0.140), attitudes toward aging (r=0.148), and mean age (r=0.163) (all P<0.001). Poorer ADL, more negative attitudes toward aging, and older age were associated with a greater feelings of uselessness. After controlling for gender, education, marital status, number of cohabitants, household registration, and self-rated economic status, the moderated mediation model analysis showed that ADL had a direct effect on feelings of uselessness (β=0.082, P<0.001); attitudes toward aging had an indirect effect on feelings of uselessness (β=0.010, P<0.001); and age played a negative moderating role on the influence of ADL on feelings of uselessness (β= –0.003, P=0.001).

Conclusions Poorer ADL was associated with greater feelings of uselessness among older adults in China. Attitudes toward aging became more negative as ADL declined, indirectly increasing feelings of uselessness. However, the influence of ADL on feelings of uselessness gradually decreased with increasing age.