Perceived burdensomeness was associated with lower happiness among older adults living with their families, primarily through reduced mental well-being and increased loneliness, with more than two-thirds of the total association operating indirectly through these serial mediators.
Key Findings
Results
Perceived burdensomeness was negatively associated with happiness in older adults cohabiting with family members.
The total association between burdensomeness and happiness was negative (β = -0.467)
Sample consisted of 266 older adults aged ≥65 years residing with family members in a city in Turkey's Eastern Black Sea region
Data were collected from 273 older adults; after preliminary screening, 7 cases were excluded, resulting in a final analytic sample of N = 266
Study design was cross-sectional
Results
More than two-thirds of the association between perceived burdensomeness and happiness operated indirectly through mental well-being and loneliness.
Serial mediation was tested using a regression-based approach with bootstrap confidence intervals
The indirect pathway accounted for more than two-thirds of the total negative association between burdensomeness and happiness
The mediation pathway was sequential: perceived burdensomeness → reduced mental well-being → increased loneliness → lower happiness
Measures included the Geriatric Feelings of Burdensomeness Scale, WHO-5, the Happiness Scale, and the Loneliness Scale for the Elderly
Results
Perceived burdensomeness was associated with lower mental well-being among cohabiting older adults.
Mental well-being was measured using the WHO-5 instrument
Mental well-being served as the first mediator in the serial mediation model
This association was part of the indirect pathway linking perceived burdensomeness to reduced happiness
Results
Perceived burdensomeness was associated with higher loneliness among cohabiting older adults.
Loneliness was measured using the Loneliness Scale for the Elderly
Loneliness served as the second mediator in the serial mediation model, following reduced mental well-being
Higher loneliness was associated with lower happiness in the mediation chain
This finding indicates that even older adults living with family members can experience significant loneliness when they perceive themselves as burdensome
Conclusions
The authors recommend routine psychosocial assessment and family-centered interventions in geriatric nursing and primary care settings.
Routinely assessing perceived burdensomeness, mental well-being, and loneliness is suggested as a clinical practice implication
Implementing family-centered and social support-oriented interventions may help improve happiness in this population
The study population was specifically older adults cohabiting with family, suggesting that co-residence alone does not protect against perceived burdensomeness or loneliness
What This Means
This research suggests that older adults who live with their families but feel like a burden to them tend to report lower levels of happiness. The study, conducted with 266 adults aged 65 and older in Turkey, found that this connection between feeling burdensome and being unhappy was largely explained by two psychological factors: poorer mental well-being and greater feelings of loneliness. In other words, feeling like a burden appeared to first reduce mental well-being, which in turn increased loneliness, ultimately leading to lower happiness — and together these two pathways accounted for more than two-thirds of the relationship between perceived burdensomeness and unhappiness.
A notable finding is that simply living with family did not protect older adults from feeling lonely or perceiving themselves as a burden. This suggests that the quality and nature of family relationships matter more than physical co-residence alone. The study measured these concepts using established psychological scales for burdensomeness, well-being, happiness, and loneliness, and tested how they relate to each other using statistical mediation analysis.
This research suggests that healthcare providers — particularly those in geriatric nursing and primary care — should regularly check for feelings of burdensomeness, poor mental well-being, and loneliness in older patients, even those who appear to have family support at home. Addressing these psychosocial factors through family-centered approaches and social support programs could be important for improving the emotional well-being and happiness of older adults.
Akeren Z, Akeren I, Kalyoncuo S. (2026). Perceived burdensomeness and happiness in cohabiting older adults: The serial mediating roles of mental well-being and loneliness.. Geriatric nursing (New York, N.Y.). https://doi.org/10.1016/j.gerinurse.2026.104003