The Role of Older Persons' Environment in Aging Well: Quality of Life, Illness, and Community Context in South Africa

The Relationship Between Quality of Life and Depressive Symptoms Among Jordanian Community-Dwelling Older Adults

OBJECTIVE

The current study aimed to examine the relationship between depressive symptoms and quality of life among Jordanian community-dwelling older adults.

METHODS

A cross-sectional, descriptive correlational design was used. A convenience sample (N = 602) was selected to recruit the participants in the Amman governorate during the period from August to November 2021.

RESULTS

Findings demonstrated that the mean (SD) age of older adults was 67.5 (7.0) years and 51.5% of participants were females. Also, 54.1% of the participants experienced moderate to severe depressive symptoms with a total mean (SD) score was 8.57 on a scale of 0 to 15, while the mean (SD) for the quality of life scale was 12.12 (3.85) on a scale of 4 to 20. Significant differences existed in quality of life and depressive symptoms based on marital status (p < .001), educational level (p < .001), working status (p < .01), income (p < .001), and chronic disease (p < .01). Quality of life and its domains were negatively associated with depressive symptoms (B= - 0.596, p < .001). Also, marital status, working, educational level, income, and chronic disease were associated with depressive symptoms.

CONCLUSION

Strategies to improve quality of life should be promoted to minimize depressive symptoms among older adults and consider significant demographic factors.

Quality of life of older adults and associated factors in Ghanaian urban slums: a cross-sectional study

OBJECTIVE

This study provides insight into the quality of life (QoL) of older adults living in urban slums in Ghana.

DESIGN

The study employed a community-based, cross-sectional design to assess QoL among older adults in two slums between April and May 2020. QoL was assessed using the WHO Quality of Life-Brief version (WHOQOL-BREF) questionnaire.

SETTINGS

Participants were drawn from two slums in Ghana, one in a fishing-dominated community and the other in an industrial community.

PARTICIPANTS

This study included 400 participants aged 60 and above who had lived in either slum for at least 1 month and were able to communicate verbally.

RESULTS

Although the means of all participants' transformed scores were poor in the physical and psychological domains, they were moderate in all other domains. When viewed as a whole, the perceived overall QoL is neither poor nor good and participants were neither satisfied nor dissatisfied with their health. Participants had a moderate level of QoL in the WHOQOL-BREF psychological (mean score 45.7), social (mean score 57.0) and environmental (mean score 51.6) domains. The mean score for physical QoL of older adults was 43.3, which denotes poor QoL. In all domains, male participants have a significantly higher mean QoL than their female counterparts. An analysis of variance comparing the living arrangements of participants showed that those who lived with extended family had high mean scores in environmental QoL, overall QoL and satisfaction with health. Regression analysis revealed that QoL was influenced mostly by the environmental (46.2%), followed by the psychological (43.7%), physical (31%) and social (20.4%) domains.

CONCLUSIONS

The findings from this study show that older adults living in slums had moderate psychological, social and environmental QoL and poor physical QoL. Although the mean scores for QoL are higher than anticipated, health policy development must take into account the specific needs of older adults.

Exploration of service centres for older persons in the Eastern Cape province, South Africa

Background

Objective

Method

Results

Conclusion

Clinical implications

Developing indicators of age-friendly neighbourhood environments for urban and rural communities across 20 low-, middle-, and high-income countries

Background

By 2050, the global population of adults 60 + will reach 2.1 billion, surging fastest in low- and middle-income countries (LMIC). In response, the World Health Organization (WHO) has developed indicators of age-friendly urban environments, but these criteria have been challenging to apply in rural areas and LMIC. This study fills this gap by adapting the WHO indicators to such settings and assessing variation in their availability by community-level urbanness and country-level income.

Methods

We used data from the Prospective Urban and Rural Epidemiology (PURE) study’s environmental-assessment tools, which integrated systematic social observation and ecometrics to reliably capture community-level environmental features associated with cardiovascular-disease risk factors. The results of a scoping review guided selection of 18 individual indicators across six distinct domains, with data available for 496 communities in 20 countries, including 382 communities (77%) in LMIC. Finally, we used both factor analysis of mixed data (FAMD) and multitrait-multimethod (MTMM) approaches to describe relationships between indicators and domains, as well as detailing the extent to which these relationships held true within groups defined by urbanness and income.

Results

Together, the results of the FAMD and MTMM approaches indicated substantial variation in the relationship of individual indicators to each other and to broader domains, arguing against the development of an overall score and extending prior evidence demonstrating the need to adapt the WHO framework to the local context. Communities in high-income countries generally ranked higher across the set of indicators, but regular connections to neighbouring towns via bus (95%) and train access (76%) were most common in low-income countries. The greatest amount of variation by urbanness was seen in the number of streetscape-greenery elements (33 such elements in rural areas vs. 55 in urban), presence of traffic lights (18% vs. 67%), and home-internet availability (25% vs. 54%).

Conclusions

This study indicates the extent to which environmental supports for healthy ageing may be less readily available to older adults residing in rural areas and LMIC and augments calls to tailor WHO’s existing indicators to a broader range of communities in order to achieve a critical aspect of distributional equity in an ageing world.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12438-5.

Functional capacity and risk of frailty syndrome in 85-year-old and older women living in nursing homes in Poland

Maintaining sufficient physical fitness to prevent any limitations in performing activities of daily living and to be functionally independent is of great importance for both longevity and quality of life in older adults. Aim of the study was to evaluate functional physical fitness of women aged 85 years and older, residents of nursing homes, in the Polish population and to assess the risk of frailty syndrome. The study involved 17 women aged 85 years or older, residents of nursing homes in the Lower Silesian voivodeship. The Senior Fitness Test was used to assess functional fitness. The results of functional fitness tests were related to the standards for the elderly population in Poland and to the reference standards for maintaining independence. In addition, hand grip strength level was measured using a hand dynamometer, height and weight were measured, and BMI was calculated. 15-item version of the Geriatric Depression Scale was used to assess the level of depression. We used 3 of the 5 proposed criteria from the Cardiovascular Health Study Frailty Index to assess the presence of frailty syndrome: gait speed, level of hand grip strength, and the presence of depression. The results of the Senior Fitness Test demonstrate the low level of functional fitness of female nursing home residents. A large percentage of the women surveyed are below the standard values developed for Polish seniors. The weakest results were in the timed up and go test, with more than 94% of the women tested falling outside the standard ranges. The mean results of all samples do not meet the developed reference standards for maintaining independence. No non-frail person was found among the study participants and the vast majority were at risk for frailty syndrome. Most of the studied women do not meet functional fitness standards developed for the Polish population, as well as reference standards for maintaining independence. Nursing home residents over the age of 85 are at risk for frailty syndrome.

Preferences of seniors living in selected Baltic Sea region countries towards the use of indoor public space furniture

Demographic changes can be observed all over the world. The number of seniors located in the societies of well-developed countries continues to rise. Both enterprises and governments need to be prepared for such changes. Consequently, public spaces need to evolve to reduce problems related to ageism and be friendly to all. Much attention is currently being paid to finding solutions for redesigning public spaces and adjusting them to the needs and requirements of senior citizens. To identify the preferences of seniors in relation to the characteristics of furniture in indoor public spaces, a survey study with 1539 respondents aged 60+ was conducted in Denmark, Finland, Latvia, Poland, Russia and Sweden. The gathered data were coded and implemented to the unified database. The statistical grouping method was used to recognize the characteristics of the needs and attitudes of seniors related to the use of public space furniture. The main variables taken into consideration in the analysis were the age and gender of respondents and their country of living. Among the most important findings are those indicating the necessity to provide the increased number of furniture for sitting in the public spaces and making sure they are not located too far away from each other. As the main disadvantages of public space furniture respondents indicated the lack of armrests or other solutions to facilitate getting up and/or sitting down, as well as profiled backrests that constitute solid support for the spine. The implementation of these data in the process of rethinking and redesigning public spaces may support the adaptation of indoor public furniture according to the requirements of a very large group of customers, namely, seniors.

"They're not leaving their home; this is where they were born, this is where they will die.": Key Informant Perspectives From the U.S. Counties With the Greatest Concentration of the Oldest Old

The "oldest old," age 85 and older, constitute one of the fastest growing segments of the U.S. population. Yet, surprisingly little is known about the characteristics of U.S. counties with the highest percentage of the oldest old, nearly all of which are rural. We used qualitative analysis of key informant interviews (n = 50) with county commissioners and other county-level representatives from rural counties with the highest prevalence of the oldest old, targeting the 54 rural counties with ≥5% of the population age 85+. We found that the rural counties with the highest proportion of residents age 85+ face unique challenges to supporting successful aging among the oldest old, including resource constraints, limited services, isolated locations, and widespread service areas. Still, interviewees identified particular reasons why the oldest old remain in their counties, with many highlighting positive aspects of rural environments and community.

Interpretative Phenomenological Analysis of the Lived Experiences of Older Adults Regarding Their Functional Activities in Ghana

Introduction: Research on disability largely draws on epidemiological data, often conducted in more developed countries. To date, there is little research related to older adults in Ghana, Africa. The purpose of this study was to strengthen understanding of how older adults in Ghana perform functional activities, referenced against the World Health Organization’s International Classification of Functioning, Disability and Health (WHO-ICF) framework. Methods: Interpretative phenomenological analysis (IPA) of semistructured interview data was employed as the methodological approach. Using purposive criterion sampling, 8 older adults admitted to Komfo Anokye Teaching Hospital in Ghana, presenting with any identified health condition and/or frailty were recruited. Results: Analysis of interview data identified 5 interrelated themes: (1) feeling anxious, (2) feeling restricted, (3) understanding and admitting difficulty, (4) striving to be healthy and being productive, and (5) managing functional difficulty. These concerns were classified and related to the WHO-ICF, particularly the contextual factors. Discussion: This study examined in detail experiences of older adults performing functional activities. Our study highlights the relevance of the WHO-ICF framework for understanding the health needs of older adults, emphasizing the functional, social, and environmental factors influencing the functional status of older adults. The findings offer unique insight into the health needs of older adults, drawing attention to the implications for policy and care.

Challenges and Assets of Older Adults in Sub-Saharan Africa: Perspectives of Gerontology Scholars

Life expectancy is increasing globally, with the biggest gains expected in sub-Saharan Africa. Using an online survey, we investigated the perspectives of gerontology scholars on the challenges of aging in sub-Saharan Africa as well as the assets of older adults. Respondents (n = 72) from 17 countries, primarily in Africa, and representing 16 disciplines, identified the top issues facing African older adults as: poverty, lack of trained geriatric professionals, food insecurity, disability/health issues, and long-term care. Older adults' unique strengths were noted as indigenous knowledge systems, being holders of cultural heritage, and their contributions to development. Respondents' biggest concerns about older adults in sub-Saharan Africa were the lack of government attention to aging issues (63%) and a lack of social services targeted to older adults' needs (57%). Government funding (77.8%) and international partnerships (38.9%) were noted as resources needed to support aging research in sub-Saharan Africa. The response or non-response of governments in sub-Saharan Africa will determine whether the growing number of older adults will increasingly experience unmet needs and whether their assets will be considered in development efforts. Establishing professional networks of gerontology scholars in the region will help to document the challenges faced by older adults, to plan for the coming demographic shift, and to empower older adults to thrive as valued community members.

The Psychological Benefits of Marriage and Children in Rural Malawi

Despite an extensive literature on the psychological rewards of marriage and children in high-income countries, research on these relationships in low-income countries remains limited. This paper draws on data from 4,133 adult women and men interviewed in the Malawi Longitudinal Study of Families and Health to examine how marital status, categorized as never, formerly, monogamously, and polygynously married, and number of children are associated with psychological well-being. With respect to marital status, we find that women in polygynous unions fare worse than monogamously married women and this detrimental effect is stronger for women than for men. Formerly married men and women of reproductive age experience the worst psychological outcomes, although this association wanes with age. In contrast, the benefits of having children is only evident among older Malawian women. These findings offer novel insights into the patterns of nearly universal marriage and high fertility that characterize Malawi and much of sub-Saharan Africa.

Relationships among Leisure Physical Activity, Sedentary Lifestyle, Physical Fitness, and Happiness in Adults 65 Years or Older in Taiwan

The purpose of this study is to understand the relationship among leisure physical activity, sedentary lifestyle, physical fitness, and happiness in healthy elderly adults aged over 65 years old in Taiwan. Data were recruited from the National Physical Fitness Survey in Taiwan, which was proposed in the Project on the Establishment of Physical Fitness Testing Stations by the Sports Administration of the Ministry of Education. Participants were recruited from fitness testing stations set up in 22 counties and cities from October 2015 to May 2016. A total of 20,111 healthy older adults aged 65-102 years were recruited as research participants. The fitness testing procedure was described to all participants, who were provided with a standardized structured questionnaire. Participants' data included sex, city or county of residence, living status (living together with others or living alone), education level, and income. Physical fitness testing was conducted in accordance with The Fitness Guide for Older Adults published by the Sports Administration of the Ministry of Education. The testing involved cardiorespiratory endurance, muscle strength, muscle endurance, flexibility, balance, and body composition. The t-test was used to evaluate the differences between continuous and grade variables under the two classification variables of sex, city or county of residence, and living status. We used the MARS (multivariate adaptive regression splines) model to analyze the effects of physical fitness variables and leisure physical activity variables on happiness. Among healthy elderly adults, sex, age, living status, body mass index, and leisure physical activity habits proved to be related to happiness. Aerobic endurance (2-min step test), muscular strength and endurance (30-s arm curl and 30-s chair stand tests), flexibility (back stretch and chair sit-and-reach tests), and balance ability (8-foot up-and-go tests and one-leg stance with eyes open tests) were found to be related to happiness. The results of this study indicate that increased physical activity and intensity, as well as physical fitness performance, are associated with improved happiness.

Social environment and quality of life among older people with diabetes and multiple chronic illnesses in New Zealand: Intermediary effects of psychosocial support and constraints

Purpose: In older people with diabetes, multimorbidity is highly prevalent and it can lead to poor quality of life. The overall purpose of this study was to examine the association between the social environment, psychosocial support and constraints, and overall quality of life among older people with and without with diabetes and multiple chronic illnesses.Methods: Self-reported data from participants in a cohort study of older New Zealanders was analysed. Responses from 380 older people diagnosed with diabetes and multiple chronic illnesses were compared with 527 older people with no health issues on indicators related to the associations of neighbourhood, health and ageing, using structural equation modelling.Results: The final model suggests that social provision, purpose in life and capabilities mediated between the social environment and quality of life, indicate that older people with positive social environment (i.e., neighbourhood advantage, residential stability) are much less likely to experience depression due to having good social support, meaningful life purpose and opportunities to engage.Conclusions: Perceived neighbourhood advantages, such as positive neighbourhood qualities, social cohesion and housing satisfaction, along with the focus on increasing social support, enhancing purpose in life and supporting one's capability to achieve, may serve as protective factors against depression.IMPLICATIONS FOR REHABILITATIONEnvironmental and personal circumstances can contribute to quality of life among older people with diabetes and multimorbidity.By providing older people with diabetes and multiple chronic illnesses a socially just environment that challenges ageism and other forms of oppression, this could reduce social disparities in health, improve inclusion and access to resources.Social and healthcare professionals are encouraged to design clinical care guidelines and rehabilitation goals from a wholistic and person/client centred approach to support older people with diabetes and multiple chronic illnesses.

Getting Old Well in Sub Saharan Africa: Exploring the Social and Structural Drivers of Subjective Wellbeing among Elderly Men and Women in Uganda

While literature attempts to explain why self-reported subjective wellbeing (SWB) generally increases with age in most high-income countries based on a social determinants of a health framework, little work attempts to explain the low levels of self-report SWB among older persons in sub-Saharan Africa. Using the 2013 Uganda Study on Global Aging and Health with 470 individuals, this research examines (i) direct and indirect effects of age on SWB through social and structural determinants, and (ii) how direct and indirect effects vary by gender. Results show a significant direct and negative effect of age on SWB (β = 0.42, p = 0.01). Six indirect paths were statistically significant and their indirect effects on wellbeing varied by gender. Providing support, education, working status, asset level, financial status and financial improvement were significantly positively associated with men’s SWB, whereas younger age, providing community support, participating in group activities, number of close friends/relatives, government assistance and all socio-economic variables were significantly positively associated with women’s SWB. Strategies to address gendered economic, social and political inequalities among and between elderly populations are urgently needed.

Factors associated with leisure activities of elderly residents in rural areas

ABSTRACT Objective: To identify factors associated with leisure activities of elderly residents in rural areas. Method: Quantitative cross-sectional study carried out with 258 elderly living in the rural area of Paraná. The collection instrument addressed sociodemographic, economic, and self-reported leisure activities. The association between variables and leisure activities was verified by means of bivariate and multivariate analysis. Results: Among the elderly interviewed, 63.9% were female, and 36.1% were male, with an average of 68.3 years old (± 5.8 years). Participation in leisure activities was high (79.8%), and the factors associated with their practice were: marital status, gender, and education. Conclusion: Considering that the practice of leisure activities promotes better living and health conditions, we reinforce the need to implement actions and instruments that provide individual and collective leisure in rural areas.

Social Support, Retirement Resources, and the Gendered Experiences of Aging for Tunisian Older Adults

Cultural context plays an important role in the experience of aging. The country of Tunisia is of particular interest because limited studies on aging have been done in the past decade. The study examined data collected from Tunisian older adults in an attempt to gain additional information about their experience aging in this culture. The purpose of this study was to identify key information tied to social policy factors that have the potential to impact older adults living in Tunisia. From June to July 2017, semi-structured interviews were completed with 60 older adults covering topics about family history, daily activities, health and health satisfaction, retirement benefits and satisfaction, medical coverage, social support, service availability, feelings of growing older, as well as advice provided to younger adults. Findings include gender differences in retirement resources and benefits, sources of support, and older adults' self-reported desires for the future. This work adds to the growing body of literature concerning differences in global aging and provides greater awareness of aging in the distinctive context of Tunisia. Additional work should seek to deepen the investigation of the various social policies that impact the Tunisian older adult.

Aging and HIV-Related Caregiving in Sub-Saharan Africa: A Social Ecological Approach

BACKGROUND AND OBJECTIVES

We reviewed the literature on older adults (OAs) who are caring for persons living with HIV/AIDS in sub-Saharan Africa (SSA), with the goal of adapting models of caregiver stress and coping to include culturally relevant and contextually appropriate factors specific to SSA, drawing on both life course and cultural capital theories.

RESEARCH DESIGN AND METHODS

A systematic literature search found 81 articles published between 1975 and 2016 which were reviewed using a narrative approach. Primary sources of articles included electronic databases and relevant WHO websites.

RESULTS

The main challenge of caregiving in SSA reflects significant financial constraints, specifically the lack of necessities such as food security, clean water, and access to health care. Caregiving is further complicated in SSA by serial bouts of caring for multiple individuals, including adult children and grandchildren, in the context of high levels of stigma associated with HIV. Factors promoting caregiver resilience included spirituality, bidirectional (reciprocal) caregiving, and collective coping strategies.

DISCUSSION AND IMPLICATIONS

The creation of a theoretical model of caregiving which focuses more broadly on the sociocultural context of caregiving could lead to new ways of developing interventions in low-resources communities.

Aging in Tunisia

Owing in part to its diversity of citizenship, Tunisia has a rich history of economic and social changes-including some of the same age-based demographic changes witnessed globally. Faced with an increasing older population and fewer young adults available to provide support, the government of Tunisia has implemented policies for the older population. These new governmental policies are intended to provide limited funds for older adults to supplement financial assistance provided by their families. Yet, even with a demographic transition occurring, recent published research on the aging Tunisian adult is limited at best. Policy change and research that improve the well-being of Tunisia's aging population must be based on adequate data. Thus, understanding the state of aging in Tunisia provides policymakers and researchers more complete information to use in decision making. Further studies should address more aspects of the Tunisian aging experience and add data that are more contemporary.

Perceived quality of life and living arrangements among older rural South Africans: do all households fare the same?

This study explores how living arrangements influence perceived quality of life in an elderly population in rural South Africa. We use data from the longitudinal World Health Organization Study of Global Ageing and Adult Health Survey (WHO-SAGE) and from the Agincourt Health and Socio-Demographic Surveillance System (HDSS). On average, older men and women who reside in single-generation and complex-linked multigenerational households report worse quality of life than those in two-generation and linear-linked multigenerational households. However, after controlling for prior wellbeing status, we find living arrangements to have a significant impact on women's perceived quality of life only, and that it is moderated by age. We conclude that not all multigenerational arrangements are protective of older adults’ wellbeing and highlight the gendered impact of living arrangements on quality of life. These results suggest the necessity to understand how living arrangements influence the social roles of older adults and change with age.