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Table of Contents   
ORIGINAL ARTICLE  
Year : 2017  |  Volume : 10  |  Issue : 4  |  Page : 861-868
The correlation of aging perceptions and life satisfaction in Iranian older adults


1 Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Medical Ethics and Law Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Department of Biostatistics, Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

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Date of Web Publication5-Oct-2017
 

   Abstract 


Background and Aim: The main challenge of world health change to outlive with better quality in 21st century. Positive self-evaluation in aging process associated with increasing in the quality of life and longevity. The concept of life satisfaction is the subjective image of human's welfare. Aging perceptions and life satisfaction are different among various cultures. The aim of this study is to investigate the correlation of aging perceptions and life satisfaction in Iranian older adults in 2016. Methods: In this descriptive, correlational study, a convenience sampling was used. A total of 320 older adults aged 60 and over in Tehran city were selected in 2016. Information was collected using demographic questionnaire, Barker et al.'s Aging Perceptions Questionnaires and Diener's Satisfaction with Life Scale. Data were analyzed using inferential and descriptive statistics by SPSS software version 19. Results: The results demonstrated that the mean score of various dimensions of aging perceptions was at medium level, and the mean score of life satisfaction was 22/39 ± 6/19 that was in low satisfied level and all dimensions of aging perceptions except identity dimension had correlated with life satisfaction (P < 0.05). Conclusion: Based on the findings several dimensions of aging perceptions have correlation with life satisfaction and various dimensions score of aging perceptions was at medium level, and life satisfaction score was in low satisfied level, it is essential to focus on educations that reinforce and encourage positive perceptions and controls in elderly people and also with social support might improve the negative concepts of aging in society. In this way, we can help to protection health and more life satisfaction in older adults.

Keywords: Aging perception, life satisfaction, older adults

How to cite this article:
Kiarsipour N, Borhani F, Esmaeili R, Zayeri F. The correlation of aging perceptions and life satisfaction in Iranian older adults. Ann Trop Med Public Health 2017;10:861-8

How to cite this URL:
Kiarsipour N, Borhani F, Esmaeili R, Zayeri F. The correlation of aging perceptions and life satisfaction in Iranian older adults. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Sep 19];10:861-8. Available from: http://www.atmph.org/text.asp?2017/10/4/861/215854



   Introduction Top


The percentage of the world's elderly population (aged 65 and older) in 2011 was 8%. In 2050, this value will reach 15.6%.[1] Based on a report from the Statistical Center of Iran, the rate of the elderly people aged 60 and older increased from 7.2% to 9.2% in 2011.[2] According to definition of the United Nations, if the percentage of the elderly population in a country is >7% that country has an aging population.[3] An increase in the population aged 65 and older, influences social services and health agencies and health-care providers, especially geriatric nurses.[4] One of the main needs of older adults is their psychological needs.[5]

Aging perception influence social behaviors, expectations of elderly people, sense of well-being, and compatibility with process of aging.[6] Individuals with a positive perception of aging show an appropriate compatibility with aging. Strategies for coping with aging should be studied in the cultural context of any society.[7] Aging perception refers to the individual perception of their own physical and psychological conditions in aging. Accurate measurement of aging perception can be an indicator for predict a person's health status in the future, person's satisfaction of his aging, and compatibility with life changes in this process and mortality.[8],[9],[10] All aspects of knowledge, understanding, experience, evaluation, interpretation, and understanding of the aging process of one's self can be placed in this concept. Aging reflection from the elderly people's view is closer to reality.[11] Many authors believe that nurses and other members of the health team by awareness of this concept can provide guidance for offering of necessary cares for protection of the elderly's health and independence.[11],[12] Aging perception evaluates various aspects of health and well-being in the elderly people. A group of the elderly people have a positive perception of aging and another group never accept being old.[13] The way a person perceives himself and his functional abilities, determine the role he plays.[14] Changes in the aging process have profound effects on the life and mental health of individuals.[5],[15] If an older adult perceives these changes in a negative way, the level of flexibility and compatibility will decrease.[5] The elderly people need a positive attitude toward themselves to become compatible with the process of aging rather than an apathetic attitude, therefore, nurses can investigate nursing cares that strengthen and encourage a positive attitude.[16]

Life satisfaction is an important factor in a person's welfare, and there is a close relationship between physical and mental health and life satisfaction. Evaluation of life satisfaction is confirmed as a valid step in the evaluation of the rehabilitation of the elderly people and determination of the effectiveness of the offering of health-care services for them.[17] One of the positive psychological concepts which recently received attention is the concept of life satisfaction. In fact, life satisfaction is a general concept resulting from a person's (cognitive and emotional) perception of his entire life.[18] An indicator of welfare is life satisfaction.[19] The core of welfare includes happiness or satisfaction caused by optimal performance.[20] The concept of life satisfaction is the subjective image of human's welfare where a person having such a subjective image can successfully cope with various life situations. In addition, having this subjective image results in a person's welfare which is related to the feeling of happiness.[21] Experts believe that life satisfaction plays an important role in the quality of life of the older adults.[22] Dimensions of life satisfaction include recreation, marriage, employment, standard of living, family, and physical health.[23] Life satisfaction can be considered as the most comprehensive evaluation of individuals of their living conditions.[24] Individuals with a high sense of life satisfaction can experience more positive emotions and have a positive evaluation of themselves, their past and future, others, and their surrounding events and describe them as being pleasant. While individuals with a low life satisfaction evaluate themselves, their past and future, others, their surrounding events and life situations as being unpleasant and experience more negative emotions such as anxiety and depression.[25]

By determining the level of life satisfaction in the older adults and their aging perception, we can understand the importance of education and support by nurses, social, and family support for elderly people to increase the knowledge and perception of the elderly people so they would experience healthy aging process along with a better life satisfaction.


   Methods Top


The present study is a descriptive, correlational research. The statistical population consists of the elderly people of Tehran city, and according to the pilot study, the minimum significant correlation between the dimensions of aging perception and life satisfaction questionnaires was obtained as 0.18. Therefore, with 95% confidence and test power of 90%, the minimum sample size required for the main study using this formula was obtained as being 320 samples, which, the samples were selected from the older adults aged 60 and older residing in Tehran city through convenience sampling. The researchers visited the parks of the five districts of Tehran (North, South, Central, East, and West) and selected the elderly people who have study inclusion criteria (i.e., age 60 and over, residence in Tehran city, and ability to read and write persian).

Data collection tools included demographic questionnaire, Barker et al.'s Aging Perceptions Questionnaires (APQs) and Diener's Satisfaction with Life Scale. Barker et al.'s APQ have been used to investigate aging perception. This questionnaire is a comprehensive and multidimensional tool that can help our understanding of individuals' experience of aging and helps identify individuals who are susceptible to a negative perception and incompatibility with the aging process and includes the investigation of eight different dimensions, including timeline chronic, timeline cyclical, positive consequences, negative consequences, positive control, negative control (scores calculate reverse), emotional representations and is set based on a 5-point Likert scale from strongly disagree to strongly agree. Its 8th dimension is the identity dimension which evaluates the percentage of health changes related to aging.[26]

Chen et al. in research performed with the purpose of investigating the reliability and validity of the Chinese version of the APQ, stated that the reliability of the test-retest was satisfactory. The Cronbach's alpha coefficient was 0.884. The correlation coefficient of all dimensions was >0.4. Content validity index (CVI) >0.99 and 8 dimensions had strong correlation.[27] Also in Iran, their reliability and validity were investigated by Sadegh Moghadam et al. (2016). The results showed and appropriate validity for the Persian version of the APQ (r = 0.94, P = 0.001). The Cronbach's alpha coefficient for the overall questionnaire was 0.75 and for its dimensions ranged from 0.53 to 0.77. In addition, an appropriate validity (CVI > 0.9) was obtained for it.[28]

Diener's Satisfaction with life scale was prepared by Diener to measure life satisfaction.[29] Diener's Satisfaction with life scale measures the positive experience of individuals instead of focusing on negative emotions.[30] The answers are based on a 7-point Likert scale. The average overall score ranges from 5 to 35.[25] A group of researchers reported the Cronbach's alpha coefficient of Diener's Satisfaction with life scale for German, Japanese, Mexican, and Chinese nationals as being 90%, 82%, 79%, and 76%, respectively.[31] In Iran, its reliability and validity were performed by Bayani et al. Its calculated Cronbach's alpha coefficient was 0.83, and the reliability coefficient of the scale was obtained through test retest as 0.699, which in general show that these tools have an appropriate reliability and validity.[32]

In the present study, to determine the validity of the questionnaires, content validity method was used. The questionnaires were given to 10 members of the faculty members of Shahid Beheshti University of Medical Sciences, School of Nursing and Midwifery, and content validity ratio (CVR) and CVI were calculated for it as CVR >0.8 and CVI >0.9. To investigate reliability, internal consistency correlation with calculation of Cronbach's' alpha coefficient was used. For this purpose, the questionnaires were given to 32 elderly people, and the results were analyzed and the Cronbach's alpha coefficient for the Satisfaction with Life Scale was obtained as 0.87 and for various dimensions of the APQ, the values were obtained as follows: timeline chronic 0.83, timeline cyclic 0.81, positive consequences 0.88, negative consequences 0.88, positive control 0.86, negative control 0.84, emotional representations 0.85, and identity dimension 0.80.

This research with the ethical code of IR.SBMU.PHNM.1395.481 was approved by the research Department of the School of Nursing and Midwifery. The anonymity of the questionnaires was emphasized. The samples were ensured that the information will remain confidential and participation in the study is free. Based on the purposes, to investigate the correlation of scores of questionnaires were used correlation coefficients (in case of the variables being normal, Pearson's correlation coefficient, and otherwise Spearman correlation coefficient). The statistical analyses were performed on SPSS software, version 19.0 for Windows, Chicago, IL.


   Results Top


Based on the results, the mean age of the samples was 67.3 ± 5.86. The samples consisted of males (53.8%), married (66.9%), education level under high school diploma (64.7%), retired (36.2%), medium income level (43.4%), under the cover of social insurance (55.3%), and also (46.6%) lived with their spouse and children.

The descriptive statistics of the APQ's dimensions in Iranian older adults in 2016 are shown in [Table 1].
Table 1: The descriptive statistics of the aging Perceptions Questionnaires dimensions in Iranian older adults in 2016

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Findings show that in dimensions of aging perception, positive consequences with score of 3.95 ± 1.01 is at a higher level compared to other dimensions, and the negative consequences with score of 2.75 ± 1.07 is at a lower level compared to other dimensions. The descriptive statistics of the life satisfaction in Iranian older adults in 2016 are shown in [Table 2].
Table 2: The descriptive statistics of the life satisfaction in Iranian older adults in 2016

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The findings in the above [Table 2] show that the mean score of life satisfaction in Iranian older adults in 2016 was 22.39 ± 6.19 which is at a low satisfied level.{Table 2}

The correlation tests of aging perception (based on its dimensions) and life satisfaction in Iranian older adults in 2016 are given in [Table 3].
Table 3: The correlation of aging perception (based on its dimensions) and life satisfaction in Iranian older adults in 2016

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The results show the maximum of positive correlation is for positive control dimension and the maximum of negative correlation is for emotional representations dimension.


   Discussion Top


Based on the main purpose of the present study, there is a weak and significant positive correlation between the dimensions of timeline chronic, positive consequences, positive control, negative control (scores calculate reverse thus high score show positive perception) with life satisfaction. The dimensions of timeline cyclical, negative consequences, emotional representations have weak and significant negative correlation with life satisfaction. The identity dimension (percentage of health changes related to aging) does not have a significant correlation with life satisfaction, which shows that health changes do not influence the life satisfaction of older adults in this study. Suh et al. reported that the level of life satisfaction was clearly different based on health status (P = 0.001). Individuals with an average or higher health status had a higher life satisfaction [16] which does not match the results of the present study. It seems that older adults in this study consider the effect of factors such as income, employment, and health insurance on life satisfaction to be greater than health changes. This can also be due to paying attention to the spiritual aspects of life instead of paying attention to the physical body in Iranian older adults.

Results show life satisfaction increase with increasing in the score of timeline chronic. Since acceptance of aging as a continual and natural process is important in older adults. Thus, older adults who have accepted aging process as a continual and natural process in their life, have felt more satisfaction with their life. In addition, life satisfaction increases with increasing in the score of positive consequences in older adults. It seems older adults through thinking positive try to change aging consequences into positive consequences.

Other results of the present study show life satisfaction increase with increasing in the score of positive control in older adults. It seems older adults through receiving social support, thinking positive, increase in self-concept, communicate with their children and society for decrease of their loneliness sense and getting their support try to have more positive control on relationship with others and obtaining of positive dimensions, advantages of aging, and independence that eventually life satisfaction increase.

Results show negative control because of reverse scoring has positive correlation with life satisfaction. Elderly people who have no control on their social living, activities, happiness in aging process can not compatible with aging changes, and have low life satisfaction. With encourage them to increase activity and social communications, they can have more life satisfaction.

In addition, life satisfaction decreases with increasing in the score of timeline cyclical in older adults. If awareness, attention, and feeling of elderly people about aging change periodically, it shows that the acceptance of aging is low in elderly people and life satisfaction cannot increase.

Based on the findings, life satisfaction decreases with increasing in the score of negative consequences in older adults. Elderly people who belief aging had negative effects on their life such as decreased ability to perform tasks, decreased independence with aging. They have no sufficient compatibility with aging consequences, thus their life satisfaction decrease.

Results show life satisfaction decrease with increasing in the score of emotional representations such as anxiety, depression, and anger in older adults. Older adults with more negative emotional representations have low compatibility with aging. Since happiness relates with life satisfaction,[21] therefore, existence of emotional representations lead to decrease happiness and cause low life satisfaction in older adults.

Based on the results, the mean score of timeline chronic in older adults was obtained as 3.39 ± 0.98 which shows that the perception of older people about this issue that their age is always increasing is at an above average level. In the research of Barker et al., the mean score of the dimension of timeline chronic was obtained as 2.90 ± 0.87[26] which differs from the results of the present study. Perception of Irish older people about this topic that “aging is continual process” was at low level against Iranian older people. In the opinion of the researcher, this difference can be due to cultural and religious differences of Iranian and Irish societies. Iranian elderly people consider aging as a natural part of their life, continual, and god given matter based on their cultural and religious teachings.

The mean score of timeline cyclical is 3.25 ± 0.86 which shows that periodic change in the awareness, attention, and feeling of elderly people about aging is at an above average level. In the study of Ingrand et al. (2012), its values were obtained as 2.88 ± 1.09.[7] Periodic change in the awareness, attention, and feeling of Iranian elderly people about increase in their age was more than Irish elderly people. Maybe, existence of negative aging concepts about aging in society change attention to aging periodically, and this issue can be the cause of the difference in the results.

The mean score of positive consequences is 3.95 ± 1.01 which shows above average level of beliefs in that “aging brings positive outcomes for elderly people” (e.g., the personality of elderly people grows as they age and they find a better understanding of matters). Ingrand et al. (2012), reports its value as being 3.22 ± 0.81[7] which was lower than the results of the present study. Since elderly people in Iranian society are more respected in society and by children than the elderly people in Western societies and still many elderly people live with their children and support by family and society, elderly Iranian people consider the positive outcomes of aging as being more. In addition, in Iranian culture, the elderly people are seen as a source of experience, which may influence the belief of elderly people in that aging brings them positive outcomes.

The mean score of negative consequences is 2.75 ± 1.07 which shows that the belief of the elderly in that “aging has a negative effect on their life” (e.g., decreased the ability to perform tasks, decreased independence with aging), is at a medium level. Burke et al. reported that the majority of elderly people had a negative attitude toward the negative consequences of old age [33] which is similar to the results of the present study. Furthermore, in the research of Ingrand et al. (2012), its value was obtained as being 3.46 ± 1.04[7] which was more than the results of the present study. It seems this difference can be due to the Iranian society's influence on the culture of respect toward the elderly people and maybe due to this reason that many of Iranian elderly people living with their children and support by family and society. This reasons caused Iranian elderly people had less negative consequences and more positive consequences.

The mean score of positive control is 3.70 ± 0.98 which shows that the belief of the elderly people in that they have control on experiences caused by aging and control of aging effects depends on them (quality of social life, relationship with others, obtaining of positive dimensions, advantages of aging, and independence are under the control of the elderly individual) is at an above average level. Slotman et al. (2015) obtained the score of positive control as being 3.71 ± 0.70[13] which is similar to the results of the present study. Since in aging process, physical, spiritual, social, and family conditions influence control on aging effects; therefore, those elderly people with better said conditions can better perform daily living activity independently compared to others and have a greater control on their own life. In this regard, changing negative aging concepts such as age discrimination to positive concepts can be effective. In recently years, social conditions for the acceptance of aging developed, therefore, negative aging concepts become less and quality of life and independency in older adults grow more.

The mean score of negative control is 3.30 ± 0.98 (scoring was reverse, therefore, lower score shows more negative control). The results state that the belief of the elderly people in that they do not have any control over experiences caused by aging and everything is out of their control (for example, they have no control over activity, mobility, happiness, liveliness in their aging process, and social life) is at medium level. Slotman et al. reported its value as being 2.43 ± 0.77[13] which Dutch elderly people reported more negative control, compared to Iranian elderly people. The reason can be due to the previous discussion about positive control that Iranian elderly people keep their communication network in aging process, so their self-confidence increase and they have more positive and less negative control on their experiences caused by aging.

The mean score of emotional representations is 2.82 ± 1.05 which shows that emotional answers (e.g., anxiety, depression, and anger) which are caused by aging, are at medium level. Slotman et al. (2015) reported its value as being 2.46 ± 0.85,[13] which is almost similar to the results of the present study. It seems fear of be rejected due to decreased social interaction abilities such as before reaching aging and decreasing circle of friends and fear of loneliness, loss of independence, and becoming dependent can create negative emotional responses to aging. Hosseini et al. also demonstrate aging changes caused changing in responses of individuals to stress. Retirement, loneliness, decreased income, and decreased social communications are other causes that increase stress and emotional representations. Depression is the most common of them.[29]

The score of the identity dimension (percentage of health changes which the elderly people relate them to aging) was obtained as being 50.35 ± 33.58% which shows that the elderly people relate almost half of their health changes to increased age. Barker et al. reported its value as being 65% ± 37%,[26] which differs from the results of the present study. Iranians older adults compared to older adults from other countries relate their health changes or illnesses mostly to factors other than age, such as nutrition, stress, etc., while non-Iranian older adults mostly relate these changes to increased age. This difference may be due to more worrying about providing for life and financial shortages and lack of health insurance coverage in Iranian older adults more than other countries older adults. These shortages make Iranian older adults relate their health changes to these shortages instead of relating them to aging. Therefore, giving awareness in this field leads to the increased perception of the elderly people of their health changes during aging.

The mean score of life satisfaction was obtained as 22.39 ± 6.19, which is at low satisfied level. In the research of Hosseini et al., the mean score of life satisfaction was obtained as being 22.94,[29] which is similar to the results of the present study. In the research of Hajizadeh and Barghamdi, the score of life satisfaction (3.72 from 7) was obtained as being medium [34] which is similar to the findings of the present research. Suh et al. reported that life satisfaction in elderly people residing in six welfare centers in South Korea is 22.50 which is at medium level [16] and matches the findings of the present study. Having financial problems, loneliness, lack of health insurance, lack of social support and family support, etc., are of reasons that influence life satisfaction in elderly people and decrease their life satisfaction. Elderly people with better economic conditions have low stress for providing for their life costs, their life satisfaction increases. Elderly people with financial independence, feel powerful in managing their life affairs, and have a greater mental health and life satisfaction compared to other elderly people. In addition, increased respect and dignity for the elderly people influences their life satisfaction.

The findings of the research show that various dimensions of aging perception almost obtained medium scores; therefore, it is necessary that nurses and other employees of the health-care system and the media provide appropriate training to elderly people to create a positive perception of aging and dealing with changes caused by aging. In addition, life satisfaction in Iranian older adults in 2016 is at a low satisfied level; therefore, it is necessary that by focusing on the various dimensions of the life of elderly people, especially factors influencing life satisfaction, help to increase life satisfaction in elderly people.

By investigating life satisfaction, groups exposed to danger can be better identified, and preventive measures can be taken to protect their health from decreasing.[35] In addition, the results of present study showed that all dimensions of aging perception except identity dimension (percentage of health changes related to aging), have a significant correlation with life satisfaction, therefore, with focus on trainings that encourage and reinforce positive perception and internal positive control in the elderly people, and also through social support and educating their families and caregiver, it is possible to change negative concepts of aging to positive concepts attributed to aging.[36] Hence, this would help to protect the health and independence and life satisfaction of the elderly people and increase their quality of life.

The effect of knowledge and attitude in elderly people on life satisfaction is clear. Therefore, an educational program for elderly people to increase their present knowledge about a positive outlook of aging is necessary.[13] Negative concepts related to aging in association with health and life satisfaction can be improved.[33] Creation of balance between various dimensions of life and increase of positive perception of aging, increase an elderly people's flexibility and compatibility with aging which ultimately leads to increased life satisfaction.

In addition, acceptance of aging and planning for it must start from the time before aging and compatibility with aging must be created according to physical, family, social, and economic conditions. If compatibility and aging perception take place correctly, life satisfaction increases and this issue increases the quality of life in elderly people and the respect and dignity of the elderly people will be protected, therefore, smart planning for the elderly people before aging and through social support is practicable.[37]

Limitations and future researches

The first limitation of the present study is related to the convenience sampling because through random sampling, the generalizability of samples increases. Another limitation is related to the ability to read and write Persian, as an inclusion criteria; therefore, the illiterate elderly people were removed and the research sample became less varied. In addition, factors such as culture and personality background of individuals may influence their aging perception and life satisfaction, and this is a limitation that the researcher cannot control. The next limitation is related to the absence of extensive research related to the study topic which did not allow for a more extensive comparison of the results.

For future studies, it is recommended that to increase the generalizability of the samples, sampling be performed in a random way and illiterate elderly people be incorporated into the research. In addition, aging perception in individuals older than 30 should also be investigated because through this method, their educational needs regarding the process of aging can be discovered and with foresight efforts can be try to eliminate their educational shortages of future older adults. In addition, it is recommended facilitator and inhibitor factors in the increase of perception and awareness of elderly people from aging and life satisfaction must be investigated. In addition, a comparative study should be performed on aging perception and life satisfaction in elderly people in rural and industrial societies.


   Conclusion Top


Positive aging perception in contrast with negative aging perception in elderly people is clearly related to their life satisfaction. Nurses and other health team members should focus on trainings that encourage and reinforce positive perception, internal control, thinking positive, increasing activities of daily living, communication with family and friends in older adults, in this way and also with social support, family and caregivers support, aging acceptance, and compatibility with aging increase. In this way, older adults can protect their health and dignity and achieving high level of life satisfaction and change negative concepts of aging to positive concepts attributed to aging. Individuals with a higher aging perception had a higher life satisfaction.

Acknowledgment

This study is the result of a Master's thesis of Medical-Surgical Nursing Education. The researchers thank all the older adults participate in the study who helped us carry out this research with their patience and we also thank all the colleagues who participated in this project.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Correspondence Address:
Fariba Borhani
Medical Ethics and Law Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ATMPH.ATMPH_232_17

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