Factors related to successful aging among community-dwelling elderly in Wenzhou, China
Article Category: Original Article
Published Online: Mar 20, 2023
Page range: 65 - 71
Received: Sep 29, 2022
Accepted: Nov 11, 2022
DOI: https://doi.org/10.2478/fon-2023-0007
Keywords
© 2023 Chen-Yu Gu et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
The elderly population is increasing globally. Since the 1970s, aging populations have been the trend in most countries. With longer life expectancy and declining birth rates, the proportion of older people is rising steadily. The World Health Organization estimates about 10% of the world’s population to be aged >60 years and 6% aged >65 years resulting in aging societies. By 2050, the elderly proportion of the world’s population is projected to jump from 12% to 22%.1 The global number of older people will nearly double, reaching 1.5 billion over the next 3 decades.2 In developing countries, the older population growth rate is the largest and the fastest. Furthermore, an aging population impacts a society’s economy, education, employment, and healthcare system, impeding the country’s development.3
The rapid growth and increasing size of the older population, unbalanced regional development, and many nations experiencing aging populations before corresponding economic development are significant attributes of the development of the aging population in China.4 China’s older population is now growing at unprecedented rates and magnitude. The country’s elderly accounts for >14% of its population in 2022; China will become a super-aged society (20% elderly) in 2033.
As noted, aging societies have become a global phenomenon due to declining fertility and increased life expectancy. However, China’s population is aging significantly despite the long-term implementation of family planning policies.5 Currently, the rapid growth of China’s older population poses a significant challenge in terms of the economy, policymaking, and facilities for caring for the aged. Additionally, there is a double strain due to the increase in the number of older people and the shortage of medical and healthcare resources, old-age security funds, and social support.6
This study was conducted in Wenzhou, a major commercial and central regional city on the southeast coast of China, a large city with a high number of older persons. To address the needs of its older population, the Wenzhou government has actively responded to the challenges of population aging, aiming to develop an age-friendly society and enhance the elderly quality of life. This study, by assessing successful aging and its influencing factors among the elderly in Wenzhou, Zhejiang Province, may serve as a guideline for the Wenzhou government’s efforts to improve successful aging.
Successful aging is a well-known and comprehensive strategy for dealing with aging. Successful aging is defined as having good physical and mental balance, optimal physical functioning, active social participation, experiencing psychological and spiritual connectivity, and having a strong appreciation for and realization of the significance of one’s formative years.7 Promoting successful aging reduces health care costs and social pension burden while enhancing the elderly quality of life and well-being.8 In China, there is comparatively less evidence of successful aging than is found in other countries. Therefore, based on the synthesized literature and the successful aging model described above, this study sought to examine the relationship of various factors to successful aging to promote successful aging among the elderly in Wenzhou.
This descriptive correlational study was conducted among community-dwelling elderly in Wenzhou, a large city with nearly 1.51 million elderly. Simple random sampling was used to select the participants residing in one of 4 districts of Wenzhou: Lucheng, Ouhai, Longwan, and Dongtou. Using data from the Wenzhou Bureau of Statistics, the population proportion in each district was estimated. The sample size was calculated using G-power analysis software. Based on a previous study,8 the parameters were estimated as follows: Tail = two, effect size = 0.3, α err prob = 0.05, Power (1-β err prob) = 0.8. A total sample size of 83 was calculated. The inclusion criteria were: (1) aged ≥60 years old, (2) residing in one of the 4 Wenzhou districts, (3) no cognitive impairment based on the Six Item Cognitive Impairment Test (6CIT) screening tool, (4) can communicate and understand Wenzhounese or Mandarin, and (5) willing to participate in this study.
Permission to use each instrument was obtained from the original authors before data collection. The participants were screened for cognitive impairment using the Mini-Cog tool.9 The questionnaire is composed of 6 parts and was administered in Chinese. The description of the 6 questionnaires is as follows.
The demographic questionnaire collected data on age, gender, religion, marital status, number of children, education level, monthly income, type of medical insurance, physical condition, and current illnesses.
The Chinese version of the SAI was used to measure successful aging.10 The SAI was initially developed based on Flood’s Successful Aging Theory.11 This 20-item instrument yields scores ranging from 0 to 80, with higher scores indicating more successful aging. The content validity index of the Chinese scale was 0.975, and Cronbach’s α was 0.83.
The Chinese version of the Barthel Index for ADL, developed by Mahoney and Barthel12 and Hou and Zhang et al.13, was used to assess participants regarding their ability to perform ADL. This scale is widely used as an ADL evaluation method in China due to its reliability and sensitivity. Scores for this 10-item scale range from 0 to 100, with 100 indicating no dependency, 61–99 indicating mild dependency, 41–60 indicating moderate dependency, and ≤40 indicating severe dependency. Cronbach’s α was 0.80.
The Chinese version of the SWLS was used to measure life satisfaction.14 The scale was initially developed by Pavot and Diener15 and consists of 5 items with overall scores ranging from 5 to 35. Higher scores reflect higher levels of life satisfaction. Cronbach’s α was 0.78, and the split-half coefficient was 0.70.
The SSRS was designed and compiled by Xiao16 and other mental health workers to assess social support.16 This scale was based on foreign scales and adapted to reflect Chinese culture and context. This 10-item scale is composed of 3 dimensions. Total scores range from 12 to 65 points, with ≤22 indicating a low social support level, 23–44 a moderate level, and >44 a high level of social support. Cronbach’s α was 0.73.
The GSES was developed by Schwarzer et al.17 and translated into Chinese by Wang et al.18 Scores for this 10-item scale range from 10 to 40, with higher scores indicating more self-efficacy. Cronbach’s α was 0.78.
A pilot study was conducted with 30 elderly people to test the reliability of the instruments. Cronbach’s α for the Barthel Index ADL scale, GSES, SWLS, SSRS, and SAI were 0.80, 0.96, 0.94, 0.77, and 0.94, respectively.
The data collection took place between 1 July and 20 August 2021. The 6CIT instrument, which takes 3–5 min to complete, was used to screen the elderly willing to participate in the study. A total of 83 elderly participants who met the inclusion criteria were selected. After obtaining informed consent, the data was collected through a face-to-face interview lasting approximately 30 min. The questionnaires were checked for completeness and numbered at the end of data collection. All the data were kept confidential, and only the researcher had access to the data.
The data were analyzed using Statistical Product Service Solutions (SPSS) version 21 (IBM Corporation, Armonk, New York, United States). Descriptive statistics was used to analyze the demographic characteristics of the sample. Pearson correlation analysis was used to determine the correlation between independent factors and successful aging among community-dwelling elderly. The significance level was set at
Of the 83 elderly participants enrolled in this study, 53.0% were females. Nearly half (43.4%) of the participants were aged between 70 years and 79 years (mean age = 78.42 years, SD = 7.67). A total of 41% of the participants believed in Buddhism. Most participants were married (81.9%) and had 3 or more children (71.1%). About 65.1% of the elderly had no formal education and 84.3% earned less income than the average adult in Wenzhou. Almost all participants had either agricultural (50.6%) or social (43.4%) insurance. Two-thirds (67.5%) had comorbidities, and 3-quarters (73.2%) suffered from hypertension (Table 1).
Demographic characteristics of the participants (
| Characteristics | Frequency | % |
|---|---|---|
| Female | 44 | 53.0 |
| Male | 39 | 47.0 |
| Buddhism | 34 | 41.0 |
| Catholicism | 2 | 2.4 |
| Christian | 4 | 4.8 |
| Taoism | 1 | 1.2 |
| No | 42 | 50.6 |
| 60–69 | 9 | 10.8 |
| 70–79 | 36 | 43.4 |
| 80–89 | 33 | 39.8 |
| ≥90 | 5 | 6.0 |
| No formal education | 54 | 65.1 |
| Primary school | 15 | 18.0 |
| Junior high school | 11 | 13.3 |
| High school | 3 | 3.6 |
| Married | 68 | 81.9 |
| Widowed | 15 | 18.1 |
| 1 | 2 | 2.4 |
| 2 | 22 | 26.5 |
| ≥3 | 59 | 71.1 |
| Agricultural insurance | 42 | 50.6 |
| Commercial insurance | 5 | 6.0 |
| Social insurance | 36 | 43.4 |
| No underlying disease | 27 | 32.5 |
| Comorbidity | 56 | 67.5 |
| Comorbidity (present illness) | ||
| Hypertension | 41 | 73.2 |
| COPD | 1 | 1.8 |
| Hypertension and diabetes | 9 | 16.1 |
| Others | 5 | 8.9 |
| ≤5000 | 70 | 84.3 |
| >5000 | 13 | 15.7 |
Of the five predictor factors, the elderly participants’ highest mean score was 84.58 for ADL; the lowest mean score was 28.75 for self-efficacy (Table 2).
Univariate analysis of factors associated with successful aging (
| Variables | Possible range | Actual range | Percentage of actual range | Mean | SD |
|---|---|---|---|---|---|
| ADL | 0–100 | 50–100 | 50.00–100.00 | 84.58 | 13.16 |
| Life satisfaction | 5–35 | 20–35 | 57.14–100.00 | 29.05 | 3.48 |
| Social support | 12–65 | 26–55 | 40.00–84.62 | 42.42 | 5.19 |
| Income of elderly | - | 300–8000 | 3.75–100.00 | 3413.25 | 1727.66 |
| Self-efficacy | 10–40 | 12–40 | 30.00–100.00 | 28.75 | 6.7 |
| Successful aging | 0–80 | 22–76 | 27.50–95.00 | 56.76 | 12.31 |
Over half (53%) of the participants had a high level of successful aging, and 43.4% had a moderate level of successful aging (Table 3).
Successful aging level of community-dwelling elderly (
| Successful aging level (M = 56.76, SD = 12.31) | Frequency | % |
|---|---|---|
| Low (0–27) | 3 | 3.60 |
| Moderate (28–55) | 36 | 43.4 |
| High (56–80) | 44 | 53.0 |
Pearson correlation analysis indicated that elderly income (
The relationship between selected factors and successful aging.
| Variables | ||
|---|---|---|
| Successful aging | - | - |
| ADL | 0.67 | < 0.001 |
| Life satisfaction | 0.63 | < 0.001 |
| Social support | 0.36 | < 0.001 |
| Income of elderly | 0.73 | < 0.001 |
| Self-efficacy | 0.72 | < 0.001 |
To the best of our knowledge, this was the first study on successful aging among the elderly in Wenzhou, China. Compared with other studies in China, the level of successful aging in this study was relatively high.19,20
The marital status of the elderly could influence their support system. In this study, 81.9% of the elderly were married and living with spouses. They were enthusiastic, had a better lifestyle, shared their thoughts and feelings with their spouse, and received more family support than unmarried participants. Logically, elderly people with 3 or more children would receive more moral and economic support than others. For instance, a study found that the elderly having more living children was positively related to successful aging.21
Most elderly had comorbidities such as hypertension, diabetes, COPD, and other chronic diseases, and as a result, they need increased attention and care. Wenzhou has a developed economy and good medical facilities that provide relatively favorable conditions for elderly health promotion, disease treatment, and successful aging. Even though the great majority of elderly participants had less income than the average Wenzhou adult, >90% had agricultural or social health insurance to mitigate the economic burden of health care. This additional financial support increases the willingness of older people to seek medical care and promotes earlier and better diagnosis, treatment, and recovery. It may also make them realize the significance of successful aging.
ADL is a series of basic activities that a person performs, ideally independently, as part of their daily routines. ADL is a significant indicator of an individual’s functional status, reflecting a fundamental ability to perform daily activities that foster independence, health, and physical mobility.22 ADL had a moderate positive correlation with successful aging (
Life satisfaction had a moderate positive correlation with successful aging (
Social support had a moderate positive correlation with successful aging (
This study showed that the income of the elderly was highly positively correlated with successful aging (
Self-efficacy had a high positive correlation with successful aging (
The findings of this study are similar to those conducted in other regions of Asia. For older adults, successful aging was significantly positively correlated with factors such as ADL, life satisfaction, social support, income, and self-efficacy. Nurses or other healthcare providers should pay more attention to these factors to better promote successful aging among their older patients. In addition, factors correlated with successful aging can be incorporated into the curriculum and guide nursing students in providing a comprehensive understanding of the various influencing factors associated with successful aging.
Future research should consider the possible impact of different geographical factors, such as comparing the differences in successful aging between the elderly living in urban and rural areas. In addition, studies should also compare the current situation of successful aging in different countries.