Factors influencing the subjective well being (SWB) in a sample of older adults in an economically depressed area of China

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Abstract

While the majority of older persons in China live in rural areas, research on the SWB of older individuals is generally scarce in China, and is particularly lacking as regards those who reside in remote areas. The present study investigated 360 elderly individuals in an economically depressed area of Hunan, China. The results of ANOVA showed correlation between income, level of education, social support, self-rated health (SRH) and SWB. The results of the logistic regression analysis demonstrated that education, income and social support showed unique and significant effects in predicting SWB, whereas the SRH approached significance. It was further demonstrated through pathway analysis that income and SRH directly predicted SWB, whereas education did so indirectly. These results suggest that the low SWB of elderly individuals in economically depressed areas of China could be improved through some interventions addressing the economic status, health and education. More specifically, a highly structured nursing intervention is recommended, as there is an urgent need for systematic approaches to improve public health services available to the elderly in poor and remote areas of China.

Introduction

Although China is a typical developing country in terms of its low-income economy (gross national product per capita is $1000 per year), large rural population and high fertility rate, it maintains one important characteristic of a developed country: a high growth rate of the proportion of the population accounted for by those aged 60+ and 65+ years. According to the China National Committee on Aging (2006), this trend became evident early in 1999. The number of citizens over 60 years of age reached 145 million in 2005, amounting to 10.98% of the entire Chinese population and making China the country of residence of the majority of the elderly adults of the World. Further, between 2030 and 2050, individuals over 60 years of age are estimated to reach 40–50% of the entire national population. The country's aging population represents a significant challenge for China, as it is a low-income country.

The rapid growth of the older population has attracted the attention of sociologists and psychologists in China, who have been studying factors influencing the levels of SWB among the older adults of the nation since the 1990s. In the present study, SWB was conceptualized according to Diener et al. (1999), as a broad category of phenomena that includes emotional responses, domain satisfactions, and global judgments of life satisfaction. Since China is a mostly agricultural country, 63.7% of its older adults reside in rural areas (Lu, 2002). The self-care agency and economic status of these individuals are generally lower than those of their urban counterparts (Hu et al., 2006). Yet the SWB of this large segment of the older population does not seem to have received sufficient attention of sociologists and geriatricians in the field.

The European Help Age International Project was funded by the European Union and was implemented in collaboration with the International Help Age and the China National Committee on Aging. The project based in Xiangxi, Hunan, one of China's economically most depressed areas, is a population-based, longitudinal health and economic promotion plan, aimed at helping the elderly to improve their quality of life (QoL) and welfare status in collaboration with their families and communities. QoL is commonly viewed as having two dimensions: physical and emotional (SWB). Previous studies have usually focused on the physical aspect of QoL. The present cross-sectional study was a pilot study investigating SWB and its determinants in older people. The determinants of SWB were of interest because SWB has been shown to be a significant indicator of QoL (Dijkers, 2005). Although studies focusing on the extremely poor rural elderly have not yet been carried out, on the basis of previous studies one can predict that the significant factors in determining SWB would be education (Xu et al., 2003, Hu et al., 2006), physical fitness (Xu et al., 2003, Hessert et al., 2005), and income (Hu et al., 2006). Social support may also be significant in SWB (Savelkoul et al., 2000). These four aspects were examined with the aim of identifying factors significant in influencing SWB. Hopefully, intervention strategies can be designed and implemented on the basis of this research.

Section snippets

Study population

Data were collected between September 2005 and November 2005 in four villages of Xiangxi, Hunan, where the older people amounted to 13.9–20.2% of the village population. All adults of 60 years and older who were able to speak Chinese and willing to participate in the study were enrolled. Those with adequate scores on the mini-mental state examination (MMSE) (Folstein et al., 1975), modified by Zhang (2003), and called the Chinese edition, participated. Of the 519 individuals enrolled, 388

General data

Demographic data of the sample are summarized in Table 1. The mean age of all participants was 67.5 ± 6.9 years, with a range of 60–96. Males were 207 among the participants (57.5%) and 153 were females (42.5%). With respect to level of education, 6 subjects had a senior high school degree or above (1.7%), 12 had completed junior high school (3.4%), 20 had completed higher elementary school (5.6%), and 162 had completed lower elementary school (45.0%). Of the total sample, 160 individuals were

Discussion

The mean score of SWB of older adults (9.937 ± 2.783) in this economically depressed area of China is lower than that of adults in America in 1972 (11.80 ± 2.20) (Campbell et al., 1976). This difference is possibly due to differences between the samples in terms of age, and the fact that levels of SWB in China are often much lower than those in other countries (Diener et al., 1995). The older population of the economically depressed region considered in the present study, has since been given

The status quo of community healthcare

Currently, there is a strong demand for nursing care in rural communities, and evidence suggests that this need will continue to increase. In America, data collected for the medical expenditure panel survey (MEPS) indicate that many older adults are cared for by nurses and nurse practitioners in ambulatory care settings (Peri and Charlene, 2004). In contrast, in China, community healthcare is relatively undeveloped, especially in rural and remote districts. In the villages surveyed in the

Conclusions

The present study examined the SWB of older persons living in economically depressed areas of China, and demonstrated that income, level of education and health were significant in predicting SWB in the elderly. In order to improve the SWB of the elderly, more attention should be paid to bettering their economic status, improving their living environment (including housing and external environment), improving their physical and mental health and enhancing their knowledge and awareness of

Acknowledgments

The authors gratefully acknowledge the support and funding received from the European Union-Help Age International Project (EU-HAI Project, China), the chief of these villages, who extended their assistance in the data collection of the study, and Dr. John R.Z. Abela of McGill University, who gave a lot of advices in revising this paper.

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