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ABSTRACT
Background: As
a result of increasing population's life expectancy
in Egypt, it has become important to ensure not
only that the elderly have greater longevity but
also happiness and life satisfaction.
Objective: to
evaluate factors affecting life satisfaction of
community dwelling elderly in Cairo.
Method: a cross
sectional pilot study was done on four hundred
and fifty community dwelling elderly using a structured
questionnaire adapted from different questionnaires
investigating life satisfaction and quality of
life.
Results and Conclusion: Most
of the community dwelling elderly involved in
the study are satisfied with life and their satisfaction
is associated with situations related mainly to
social relations, financial circumstances, home
and neighborhood and psychological well-being,
with good health being the most important factor
for quality of life. Elderly preferences for life
satisfaction and quality of life should be considered
in the future plans for psychological well being
of the Egyptian elderly.
Key words: elderly;
subjective well-being; life satisfaction; quality
of life.
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INTRODUCTION
The growing population
of elderly Egyptians is a well-known fact and constitutes
an evolving problem for society as a whole. According
to results of the Egyptian census in 2006; elderly (>
60 years old) constitutes 6.1% of population and the
number continues to climb (The Egyptian IDSC, 2008).
As a result of increasing population's life expectancy,
it has become important to ensure not only that the
elderly have greater longevity but also happiness and
life satisfaction. There has been increasing interest
in the subjective well-being (SWB) of the elderly population
in Egypt. SWB can be defined as a positive evaluation
of one's life associated with positive feelings. In
gerontology, general SWB has most often been assessed
with measures of life satisfaction, happiness, and self-esteem.
Whereas self-esteem and life satisfaction measure cognitive
evaluations of one's self and one's life, happiness
generally represents the emotional component (Kozma,
1991). When the life satisfaction is addressed, generally
a satisfaction related to whole life experience is understood,
rather than the satisfaction pertaining to a certain
condition. Life satisfaction can be defined as a situation
or a consequence obtained through comparing someone's
expectations (whatever desired) with possessions (whatever
gained) (Ozer, 2004)) or it is the degree to which an
individual judges the overall quality of his life-as-a-whole
favorably (Veenhoven, 1991). So, life satisfaction can
be considered as a proxy measure of subjective well-being
and quality of life in elderly. The World Health Organization
Quality of Life group defined Quality of life as "an
individual's perception of their position in life in
the context of the culture and value systems in which
they live and in relation to their goals, expectations,
standards and concerns". The subjective nature
of quality of life purports that it can be conceptualized
differently by different groups of people. Age, gender,
health status, and cultural factors are some of the
important factors that influence their conceptualization
(Najati, 2008).
Identification of factors affecting
life satisfaction of community dwelling elderly and
their references for quality of life may guide the growing
efforts to maintain high levels of life satisfaction
and good subjective well being among the Egyptian elderly.
METHODS
A survey research design was employed to conduct
this exploratory study on 450 community dwelling elderly.
The study was reviewed and approved by the Research
Review Board of the Geriatrics and Gerontology Department,
Faculty of medicine, Ain Shams University. Personal
interviews were used to collect data from a convenient
sample of elderly participating in activities of senior
social clubs in Cairo. The interviews were conducted
using orally administered structured questionnaire (adapted
from different questionnaires investigating life satisfaction
and quality of life in elderly). All questionnaires
were translated into Arabic language and back translated
by another translator to the original language with
no significant difference between the original and the
back translated forms. The questionnaire is formed of:
1- Satisfaction with Life Scale (SWLS) (Pavot,
1991): which is a short, 5-item instrument designed
to measure global cognitive judgments of one's lives.
There are five statements (In most ways my life is close
to my ideal, The conditions of my life are excellent,
I am satisfied with life, So far I have gotten the important
things I want in life and If I could live my life over,
I would change almost nothing) that subject may agree
or disagree with, using the 1 - 7 scale (from Strongly
agree to Strongly disagree). Those with very high score
(30-35) are highly satisfied, High score (25-29), Average
score (20-24), Slightly below average in life satisfaction
(15-19), Dissatisfied (10-14) and Extremely Dissatisfied
(5-9).
2- Rating of satisfaction with the following
items on a scale from 1 (not at all satisfied) to 5
(very satisfied): Social relationships, Home and neighborhood,
Psychological well-being, Social roles and activities,
Other activities done alone, Financial circumstances,
Society and politics.
3- Quality of life scale (Fernandez, 1998): Brief
questionnaire designed to determine quality of life.
It consists of conditions that are essential for quality
of life in the elderly. (The subject should choose from
these conditions the three most important ones for quality
of his/her life). These conditions include Health (to
enjoy good health), Functional abilities (to be able
to look after oneself), Economic conditions (to have
a good pension and/or income), Social relationships
(to maintain relationships with family and friends),
Activity (to stay active), Social and health services
(to have good social and health services), Quality in
the home and the immediate context (to have a good house
in a good quality environment), Life satisfaction (to
feel satisfied with life), Cultural and educational
opportunities (to have the opportunity to learn new
things).
In addition, the sociodemographic characteristics of
the participants were discussed, which included age,
sex and marital status. Self rating of health status
on a scale from 1 (very poor) to 5 (very good) was asked.
Subjects with a history or symptoms suggestive of depression
or cognitive impairment were excluded from the study.
The collected data was coded, tabulated, revised and
statistically analyzed using SPSS program (version 17).
Descriptive statistics were done for numerical data
by mean and standard deviation and for categorical data
by number and percentages. Statistical analysis was
done for quantitative variables using t-test in cases
of two groups with parametric data and ANOVA Test for
more than two groups with parametric data, while correlations
were done using Pearson correlation for parametric numerical
data and Fisher Exact test for qualitative non parametric
variables. The level of significance was taken at P
value < 0.05.
RESULTS
Four hundred and fifty
elderly (235 males and 215 females) ranged in age from
60 to 90 years were involved in this study. The mean
age of total sample population was 67.1 years (±6.3
SD). The mean age of males was 67.3 years (±6.7
SD) and they ranged from 60-90 while the mean age of
females was 66.8 years (±5.9 SD) and they ranged
from 60-88 years old. Table (1) shows the demographic
data including (age, sex and marital status) and history
of medical conditions. This study's results show that
none of these medical conditions has a statistically
significant relation with life satisfaction score in
the elderly. The study results reveal that there is
a statistically significant positive correlation between
life satisfaction score and age only above 80 years
(P value 0.008 for total and 0.009 for males). This
relation is not statistically significant in females
of the same age group and also not statistically significant
in other age groups either in total sample, males or
females. Also, the results of the study revealed that
there is no statistically significant gender difference
as regard the degree of life satisfaction (P value =
0.51) and there is no statistically significant difference
in degree of life satisfaction between elderly with
spouse (married) and those without spouse (widow, divorced
and never married) (P value = 0.23). Regarding self
rating of their health status (Table 1), 35.8 percent
of the study population (37.4 percent of males and 39.5
percent of females) perceived their health as good or
very good, 32.9 percent of the study population (16.6
percent of males and 50.7 percent of females) perceived
their health as fair (slightly good) and 28.6 percent
of the study population (45.9 percent of males and 9.8
percent of females) perceived their health as bad (poor
or very poor) with no statistically significant correlation
between perceived health status (bad, fair or good)
and degree of life satisfaction (P value = 0.15).
| Variable |
|
|
|
| Age group |
| 60-70 |
| 71-80 |
| 81-90 |
|
|
|
|
|
178
|
75.7%
|
|
45
|
19.1%
|
|
12
|
5.1%
|
|
|
|
|
|
171
|
79.5%
|
|
40
|
18.6%
|
|
4
|
1.9%
|
|
|
|
|
|
349
|
77.56%
|
|
85
|
18.89%
|
|
16
|
3.55%
|
|
| Marital status |
| Marital status |
| Without spouse |
|
|
|
|
| Perceived health
status |
| Very poor |
| Poor |
| Slightly good |
| Good |
| Very good |
| Missing values |
|
|
|
| 76 |
32.3% |
| 32 |
13.6% |
| 39 |
16.6% |
| 58 |
24.7% |
| 18 |
7.7% |
|
12
|
5.1%
|
|
|
|
| 7 |
3.3% |
| 14 |
6.5% |
| 109 |
50.7% |
| 63 |
29.3% |
| 22 |
10.2% |
|
|
|
|
|
| 83 |
18.4% |
| 46 |
10.2% |
| 148 |
32.9% |
| 121 |
26.9% |
| 40 |
8.9% |
12
|
2.7%
|
|
| Degree of life
satisfaction |
| Extremely dissatisfied |
| Dissatisfied |
| Slightly below average |
| Average |
| High score |
| Very high score |
|
|
|
|
|
3
|
1.3%
|
|
2
|
0.9%
|
|
41
|
17.4%
|
|
66
|
28.1%
|
|
75
|
31.9%
|
|
48
|
20.4%
|
|
|
|
|
|
2
|
0.9%
|
|
9
|
4.2%
|
|
35
|
16.3%
|
|
43
|
20%
|
|
68
|
31.6%
|
|
58
|
27%
|
|
|
|
|
|
5
|
1.1%
|
|
11
|
2.4%
|
|
76
|
16.9%
|
|
109
|
24.2%
|
|
143
|
31.8%
|
|
106
|
23.6%
|
|
| Medical conditions
† |
| D M |
| HTN |
| O A |
| COPD |
| IHD |
| CLD |
| CKD |
| Others |
|
|
|
|
|
63
|
26.8%
|
|
88
|
37.7%
|
|
31
|
13.2%
|
|
23
|
9.8%
|
|
42
|
17.9%
|
|
11
|
4.7%
|
|
13
|
5.5%
|
|
48
|
20.4%
|
|
|
|
|
|
63
|
29.3%
|
|
97
|
45.1%
|
|
71
|
33%
|
|
9
|
4.2%
|
|
26
|
12.1%
|
|
9
|
4.2%
|
|
4
|
1.9%
|
|
58
|
27%
|
|
|
|
|
|
126
|
28%
|
|
185
|
41.1%
|
|
102
|
22.7%
|
|
32
|
7.1%
|
|
68
|
15.1%
|
|
20
|
4.4%
|
|
17
|
3.8%
|
|
106
|
23.6%
|
|
† D M: Diabetes mellitus,
HTN: hypertension, O A: osteoarthritis, COPD: chronic
obstructive pulmonary disease, IHD: ischemic heart disease,
CLD: chronic liver disease, CKD: chronic kidney disease.
Table
1: Descriptive statistics
The results of the study also revealed that more than
half of the elderly (55.4 percent) in the studied sample
(52.3 percent of males and 58.6 percent of females)
have high or very high life satisfaction score. And
nearly 80 percent of elderly (80.4 percent of males
and 78.6 percent of females) have from average to very
high life satisfaction score (Table 1). The results
of our study also revealed that both elderly males and
females express high levels of satisfaction with social
relations, financial circumstances, home and neighborhood
and psychological well-being, and to lesser extent with
their activities and social roles while they show the
lowest levels of satisfaction with items of independence,
society and politics (Table 2).
(Click
here for Table 2)
 Figure
1: The percentage of different conditions for the quality
of life chosen to be the most important by elderly of
the studied sample
In this study, nearly 90 percent of the elderly males
and females report that good health is the most important
factor for quality of life of the elderly. Following
good health for quality of life, is to have good family
and friend's relationships, good income and feeling
satisfaction with life, and to a lower extent the availability
of health and social services, having a comfortable
house, to be active and to be independent. And the least
important factor for quality of life of the elderly
in our study is to have learning opportunities (Figure
1).
DISCUSSION
Maintaining good subjective
well being among the Egyptian elderly is a new area
of increasing concern and efforts are encouraged for
achievements in this field. Life satisfaction and quality
of life issues are crucial for that purpose. Identification
of factors affecting life satisfaction of community
dwelling elderly and their preferences for quality of
life may guide these growing efforts to maintain high
levels of life satisfaction and good subjective well
being for the elderly. This exploratory study was conducted
on 450 community dwelling elderly in Cairo with nearly
equal distribution between both sexes.
Our study results signify high levels of life satisfaction
among the sample population of community dwelling elderly
in Cairo. Despite the difference in living conditions
and standards of life, this result agrees with a cross-sectional
study which was performed in six European countries
which indicated that most of elderly were satisfied
with their lives (Fagerstrom, 2007). It could be due
to low levels of expectations of the Egyptian elderly
regarding their living conditions especially with lower
income and lower educational levels among Egyptian elderly
(68.8 percent of Egyptians > 60 years old are illiterate
and 11 percent can only read and write) (The Egyptian
IDSC, 2008).
This study's results revealed that there is no statistically
significant correlation between life satisfaction score
and age with exception of the oldest group above age
of 80 years in the total sample and in males, which
shows a highly statistically significant positive correlation.
This relation is not statistically significant in females
of the same age group probably due to smaller numbers
of females involved in this study, from this age group.
Also, our results revealed that there is no significant
association between perceived health status (poor, fair
or good) and degree of life satisfaction. This is against
the findings of Wencke et al., (2009) who found in research
applied to a group of elderly in a German community
to assess the effect of ageing and health on the life
satisfaction of the elderly, that life satisfaction
declines rapidly and the lowest absolute levels of life
satisfaction were recorded from the elderly and this
rapid decline in life satisfaction is primarily attributable
to low levels of perceived health (Wenck, 2009).
The results of our study revealed that there is no statistically
significant gender difference as regards the degree
of life satisfaction. This disagrees with many studies
that show gender differences in life satisfaction in
favor of men because of women's higher risk of being
widowed, having decreased physical strength, having
health problems, having lower educational status, and
financial dependence and needing care. On the contrary,
women may have greater access to sources of psychological
well being (e.g., relations to adult children) raising
their levels of life satisfaction (Pinquart, 2001).
Our results also revealed that there is no statistically
significant difference in degree of life satisfaction
between elderly with spouse and those without spouse.
This result agrees with the results of a study done
on Nigerian elderly which showed that items that measure
social contact, such as marital status did not correlate
at a significant level with life satisfaction index
(Baiyewu, 1992). On the other hand, many studies such
as a study done on Korean American elderly revealed
that there was a positive relationship between marital
status and life satisfaction (Song, 1992).
The results of this study also revealed that both elderly
males and females express high levels of satisfaction
with social relations. (Social support is an important
factor that affects life satisfaction among elderly
(Newsom, 1996), financial circumstances, home and neighborhood
and psychological well-being, and to lesser extent with
their activities and social roles while they show the
lowest levels of satisfaction with items of independence,
society and politics
(Table 2).
In this study, nearly 90 percent of the elderly males
and females report that good health is the most important
factor for quality of life of elderly. As noted, quality
of life of elderly patients who suffer from stable and
controlled chronic diseases can be affected by multiple
morbidities in the physical domain and probably also
in the psychological domain (Miranda, 2009). In our
study, following the good health for quality of life
is to have good family and friend's relationships, good
income and feeling satisfaction with life, and to a
lower extent, the availability of health and social
services, having a comfortable house, to be active and
to be independent. These results agree with a Brazilian
study of Xavier et al., (2003) who found that for the
elderly subjects a negative quality of life is equivalent
to loss of health and a positive life quality is equivalent
to a greater range of categories such as activity, income,
social life and relationship with the family, categories
which differed from subject to subject (Xavier, 2003).
In our study, the least important factor for quality
of life of the elderly is to have learning opportunities
and this result could be due to a higher rate of illiteracy
among Egyptian elderly or due to cultural differences
in elderly priorities and preferences (Figure 2).
High levels of life satisfaction of the Egyptian elderly
involved in this study, which is not affected by sex,
marital status or perceived health status, may be due
to religiosity as the Egyptians either Muslims (the
majority), or Christians are generally bound to their
religion. Religiosity can raise their levels of life
satisfaction especially in older ages despite their
gains in life. Intrinsic religiosity and spiritual well-being
are associated with hope and positive mood states in
terminally ill elderly people (Fehring, 1997). Barkan
and Greenwood, 2003 reported that examination of religious
and spiritual involvement indicates a positive association
with psychological well being (Barkan, 2003). A summary
of limitations of our paper includes the lack of generalizability
of the findings to all older Egyptians because of the
convenience sample that included only elders from senior
social clubs in Cairo. Also, education and religion
effect was not tested in this study.
CONCLUSION
Most of the community dwelling
elderly involved in the study were satisfied with life
irrespective of their sex, marital or perceived health
status. Elderly life satisfaction is associated with
situations related to social relations, financial circumstances,
home and neighborhood and psychological well-being,
with good health being the most important factor for
quality of life of elderly.
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