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J380 Research Methods

Published : 30-Sep,2021  |  Views : 10

Question:

Objective: Objective of the paper is to analyze the fact that aging is part of normal life, which is influenced by psychological and social factors that interfere with the aging process and sense of wellbeing in the elderly. This study focused on analyzing wellbeing, hope and participation in elderly population and evaluated the possible difference between independent and dependent groups of older adults.

Methods: This simple random sampling cross sectional study included 39 adults aged 70 and older for the “independent” group and 39 additional participants aged 70 and older for the “dependent” group. Their responses to demographic, RNLI, PWI and HIS questionnaires were statistically analyzed using independent samples t-test.

Results: Statistically significant difference (p<0.001) was found between independent and dependent groups in all three observed categories: wellbeing, hope and participation and engagement driven by spirituality for 39 adults aged 70, older for the “independent” group and aged 70, and older for the “dependent” group.

Conclusion: Wellbeing, hope and participation are powerful indicators of the quality of life of elderly and vary significantly depending on whether the older adult is dependent or independent. These served s powerful indicators for these expressed stereotyped behaviors towards their group, which are typically negative when compared to those expressed by the teenagers or middle-aged people.

Answer:

Introduction

Aging is a part of normal life, which is influenced by psychological and social factors that interfere with the aging process and sense of wellbeing in the elderly group. Positive and/or optimal aging is considered healthy aging, which does not pertain to the absence of disease or financial wellbeing but the optimal spiritual, social and health conditions that allow one to adapt positively to the process of aging.  Furthermore, healthy aging is characterized by high cognitive and physical function abilities while maintaining a positive attitude (Thanakwang et al., 2012).

The world’s population is becoming increasingly older at a rapid pace. It is estimated, by 2100 the population of 80-year-olds and older will increase seven-fold (Wong, 2014). The United States’ population of elderly persons who are older than 65 years is projected to double by the year 2060 to approximately 98 million (Population Reference Bureau). Looking at these overwhelming figures, governments will wonder if it is possible to sustain them when the time comes. As a result, many studies have been conducted to investigate how the elderly cope with the challenges of advanced age and how this affects their quality of life (Thanakwang et al., 2012). However, limited data is available on assessing the differences in quality of life in different groups among the elderly population.

This study will focus on issues of wellbeing, hope and participation in elderly population and assess the potential difference between independent and dependent groups of older adults. These groups are selected for these are the target participants of the research.  

The hypothesis for the research seeks to find whether there is a significant difference between the dependent and independent elderly persons in terms of well-being in the community. In some cases, dependent elderly are frail and do not have the capacity to walk from one place to the other (Thanakwang et al., 2012). The hypothesis for the research also inquires to find out if there is a significant difference in the participation between the independent and the dependent elderly people. The third hypothesis was to find out whether there is significant difference in the sense of hope between the dependent/independent elderly in the community. Occupational therapy (OT) may be able to significantly influence the ability to reach these hypotheses given our key role in increasing or maintaining functional independence, social participation and quality of life, both from a preventive perspective and a treatment perspective based on the research results. The results of this study can also provide data that can be used for policy making in the United States of America especially on how to take care of the ever increasing elderly population.

Methods

This is a non-experimental cross sectional study design and employs simple random sampling. All participants were randomly recruited from local neighborhoods. A total of 78 individuals, 70 and above, were voluntarily recruited and required to read and accept an informed consent, which has been approved by IRB approval committee.

Participants

Participants included 39 adults aged 70 and older for the “independent” group and 39 additional participants aged 70 and older for the “non-independent” group. The independent group consisted of individuals with no major medical, neurological, or psychiatric conditions, living in their homes. The dependent group included individuals

living in senior facilities or at home under the care of a personal caregiver. Participants

were recruited via the convenient sampling method as well as through personal contacts residing in the

Tri-state area. There were no limitations on medical history, but the participants were

required to be alert and oriented to person, place, and time. The participants signed

consent forms and were given a $20 gift card to the CVS Pharmacy as a token of

appreciation for their time.

Research Instruments

Demographic Questionnaire

Socio-demographic data and background information about their medical status was used to obtain information about the participants’ gender, age, level of education, race, marital status, medical condition, and level of independence.

Reintegration to Normal Living Index (RNLI Avolio, 2013)

The RNLI was used to rate the subjects’ participation in life activities. This is an 11-item scale and includes questions regarding important daily activities, such as mobility in the home, mobility in the community, taking trips, self-care, work activities, recreational activities, social activities, and family activities (Avolio, 2013). All questions were worded to take into consideration how satisfactory the current situation was to the individual. RNLI is an 11-item scale that was used that demanded to provide scores from less important to highly important scores. This will be in consideration to psychometric properties including community, taking trips, self-care, work activities, recreational activities, social activities, and family activities.

Personal Wellbeing Index – Adult (PWI)

The PWI scale contains eight items of satisfaction, each one corresponding to a quality of life domain such as standard of living, health, achievement in life, relationships, safety, community-connectedness, future security, and spirituality/religion. The items are rated on an 11-point response scale, ranging from 0 (“No satisfaction at all”) to 10 (“Complete satisfaction”), and include the following life domains: standard of living, personal health, achieving in life, personal relationships, personal safety, community connectedness, and future security (Cummins & amp; Lau, 2005; International Wellbeing Group, 2006). Psychometric properties include standard of living, health, achievement in life, relationships, safety, community-connectedness, future security, and spirituality/religion.

Integrative Hope Scale (IHS Cummins & amp; Lau, 2005)

The adult integrative hope scale was used to assess the patients’ trait levels of hope that is based on trust and confidence), positive future orientation and personal value/lack of perspective (Miller Hope Scale, Herth Hope Index, and SnyderHope Scale). The IHS contains 23 items that are classified into four dimensions: trust and confidence (items 1,9, 7, 5, 15, 12, 21, 18, and 23), positive future orientation (items 3, 8, 17, and 22), social relations (items 4, 11, 14, and 20), and personal value/lack of perspective (items 2, 6, 10, 13, 16, and19). Each item was answered using a 6-point Likert-type scale ranging from “strongly disagree” to “strongly agree” (Schrank, Woppmann Sibitz, & amp; Lauber, 2010). Psychometrics includes Miller Hope Scale, Herth Hope Index, and SnyderHope Scale. 

Statistical Analysis

All analyses were conducted by using IBM SPSS version 24. The research conducted an independent t-test to detect differences between groups in terms of hope, well-being, and participation.  Missing key information (descriptive statistics- type and for which of the variables). Why did you use independent t-test…were composites / total scores used or else?

Results

Demographic characteristics of the study population are shown on the Table 1 and figures 1-6. Demographics of the target participants indicate the gender,

The mean of HIS, RNLI and PWI of both groups are shown on figure 9. The mean total hope value measured by IHS instrument is (SD = 12.0864) in independent individuals, and 102.128 (SD = 15.6410) in dependent individuals. What does the descriptive means? You need to include Hope total as well as all its composites, in figure, table and text. There were sig differences bw groups in all.

The mean participation of independent individuals measured by RNL instrument is 51.5385 while the mean participation of dependent individuals is 38.0515 (SD = 10.6646). This difference is statistically significant (P < .0001).

Wellbeing in independent individuals, as measured by PWI instruments is 8.0440 (SD = 1.2788) and in dependent individuals is 6.7985 (SD = 1.9268).  The difference is statistically significant (P = 0.001).  

This section requires some work. Please indicate were tables should be inserted;

Discussion

The current research was carried out in order to investigate analyzing wellbeing, hope and participation in elderly population and evaluated the possible difference between independent and dependent groups of older adults. The results of this study are indicating a significant difference in hope, participation, and wellbeing in dependent and independent individuals. The mean hope, participation, and wellbeing values are higher in independent individuals (115.1538, 51.5385, and 51.5385, respectively) when compared to dependent individuals (102.128, 38.0515, and 6.7985, respectively). Such results indicate that dependent elderly individuals have considerably lower sense of hope in comparison to independent ones. Moreover, results with high values for independent individuals indicated that sense of participation and wellbeing values are higher among them in comparison to the dependent ones.

With increasing age, individuals develop self-stereotypes as they develop a sense of belonging to a group. This explains the reason why elderly people are more likely to express stereotyped behaviors towards their group, which are typically negative when compared to those expressed by the teenagers or middle-aged people Negative life events tend to accumulate as age increases, which causes physiological and health to decline and interferes with wellbeing. Emotional wellbeing is not compromised with aging in general but is influenced by the different family and social relations of an individual (Erez, 2015).

As the population grows older, significant attention is drawn to the concept of successful aging, which as a hallmark has participation of elderly in various aspects of life and activities. Particularly, social engagement and active involvement have been considered the main determinants of successful aging. Participation in social activities and family life creates a means for physical and social activities, which causes cognition enhancement and serves as a natural foundation for hope and wellbeing in older age (Avolio, 2013). Studies have shown that participation in leisure activities unrelated to fitness increase overall survival and improve health outcomes. Further, remaining professionally active longer has a positive impact on a person’s physical and cognitive health by lowering the risk of cognitive deteriorations, dementia and mortality risk in general. Active employment in advanced age also brings better financial status to the elderly, providing them with better healthcare and higher-quality lifestyles (Gow, 2012).

However, chronic conditions that are almost inevitable in older adults result in disabilities that require complete dependence on other people’s care. It is clear that engagement and participation are affected by disability. Studies have shown that elderly who are more socially active have lower levels of disability. This association is constant among gender, age and disability types.   Lower participation could also be the cause of further disability, following the principle “use it or lose it” (Williams, 2010).

Another factor, important for the wellbeing of the elderly, is hope. Hope is defined as a positive attitude characterized by the capability to think and derive strategies to reach particular goals by one’s self-motivation. Higher degree of hope is positively related to academic outcomes, sports and physical and psychological health. Hope and participation play a key role in the process of healthy aging and accompany the sense of satisfaction and wellbeing (Duggleby, 2009).

 Engagement might also be driven by spirituality. Specifically, spirituality is thought to be the mediator between hope and wellbeing. Defined as personal views and behaviors that express a sense of relatedness to something greater than the self, spirituality has evolved from the basic instinct of hope. As hope is important to establish a better image of a brighter tomorrow, spirituality is the basis that allows hope to express itself. Spirituality enables the person to achieve wellbeing (Smeaton, 2016).

The biological aspects of aging are less to do with the negative attitudes observed in elderly and mostly due to self-stereotyping effects (Levy, 2003). Dependent elderly people are less likely to develop social relations, maintain hope and emotional wellbeing. They mostly exhibit negative stereotypes, which negatively affects their quality of life. On the other hand, the freedom and autonomy of the independent elderly facilitate active participation in social activities and develop new relationships. Independent people mostly exhibit positive stereotypes, which contribute to better health and longer lifespan.  These people are more likely to have hope and emotional wellbeing, which increase the quality of life. However, the tendency to suffer from disease is common in both dependent and independent individuals (Lopes, 2012).

Independent individuals are more likely to participate in physical and social activities, which enhances cognition and improves hope and wellbeing. Dependent individuals, particularly disabled people, have compromised social activities and participation, which affects their level of hope (Avolio, 2013).

Functional independence and absence of chronic or serious diseases are part of healthy aging. Interaction between younger and elderly individuals results in reduced stereotypical behavior towards the process of aging. This interaction is more accessible to independent individuals than to dependent and disabled individuals, which partly explains the low participation and well-being levels in dependent individuals observed in this study (Lopes, 2012).

Emotional wellbeing and cognition are two key factors of positive functioning and wellbeing.  The differences in information processing of emotional goals in the elderly are reflected by the variation in their cognitive functioning. Having all that in mind it could be said that wellbeing and hope are tightly connected. One can state that wellbeing could be considered an outcome of hope. Hope determines behaviors and actions of individuals t1hat, in turn, influence their wellbeing. Health, combined with hope and wellbeing, enhances the quality of life and facilitates the ongoing engagement in life (Ibrahim, 2015).

Therefore, the importance of aging gracefully without neglecting hope, as well as active participation in a person’s daily life, cannot be more emphasized. Such actions ensure that the elderly will be more independent and will be able function more like able-bodied individuals, even when old age steps in and rear its ugly head by bringing all sorts of diseases and ailments (Avolio, 2013). This, in turn, can reduce their dependence on other people, which at certain times can be seen as a problem, especially if the country faces the challenge of a high number of old people who will have to be funded and taken care of.

These findings could be helpful to shape the welfare policies to address the requirements of dependent individuals. Education about the process of aging, the influence of intergenerational association, social interaction and participation on aging would be helpful to promote healthy aging.

Research Limitations and Recommendations

The discussion is more like an Introduction/lit review. Studies need to be compared and contrast with current study findings. Study limitations need to be addressed and recommendation for future research. There is a MAJOR concern with how you incorporated citations throughout the introduction, which affect anything you used in the discussion (besides the concern with the actual style and lack of proper use of scientific writing).

References

Avolio, M. et al. (2013). Factors influencing quality of life for disabled and nondisabled elderly population: The results of a multiple correspondence analysis. Current Gerontology and Geriatrics Research,2013. doi.org/10.1155/2013/258274

Cline, D. D. (2014). A concept analysis of individualized aging. Nursing Education Perspectives, 35(3), 185-192.

Cummins, R. A., & Lau, A. L. D. (2005).  Personal Wellbeing Index – Intellectual Disability (3 rd ed).  Deakin University: The Australian Centre on Quality of Life.

Duggleby, W. & Wright, K. (2009). Transforming hope: How elderly palliative patients live with hope.The Canadian Journal for Nursing Research, 41(1), 204–217. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/19485053

Erez, A.B.H. et al. (2016). Protective personality variables and their effect on well-being and participation in the elderly: A pilot study. Healthy Aging Research, 5(12). Retrieved from http://www.har-journal.com/wp-content/uploads/2016/10/HAR12-3099.pdf

Gow, A.J. , Mortensen E.L., & Avlund, K. (2012). Activity participation and cognitive aging from age 50 to 80 in the Glostrup 1914 Cohort. Journal of  American Geriatric Society, 60(10):1831–1838. doi: 10.1111/j.1532-5415.2012.04168

Hoppmann, C. A., Gerstorf, D., Smith, J., & Klumb, P. L. (2007). Linking possible selves and behavior: Do domain-specific hopes and fears translate into daily activities in very old age? The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 62(2), 104-111.

Ibrahim, S.A.S. & Akehsan, D. (2015). Engagement in occupational activities and purpose in life amongst older people in the community and institutions. Procedia - Social and Behavioral Sciences, 202(22): 263-272. doi.org/10.1016/j.sbspro.2015.08.230

JESTE, D. V., DEPP, C. A., & VAHIA, I. V. (2010). Successful cognitive and emotional aging. World Psychiatry, 9(2), 78–84.

Levy, B. R. (2003). Mind matters: Cognitive and physical effects of aging self-stereotypes. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 58(4), 203-211.

Lopes, M., Afonso, R. M., Cerqueira, M., &Pereira, H. (2012). Images of aging in institutionalized and non-institutionalized elderly people. Psychology, Community & Health, 1(2), https://doi.org/10.5964/pch.v1i2.30.

Population Reference Bureau. Family planning: A strong investment for India. Retrieved from http://www.prb.org/

Smeaton, E. et Maher, C. (2016). Supporting spiritual engagement for people living with dementia. Health and Social Care, 4(2). doi: 10.1558/hscc.v4i2.31340

Steultjens, E. M., Dekker, J., Bouter, L. M., Jellema, S., Bakker, E. B., & Van Den Ende,

H. (2004). Occupational therapy for community dwelling elderly people: a

systematic review. Age and ageing, 33(5), 453-460.

Thanakwang, K., Soonthorndhada, K., & Mongkolprasoet, J. (2012). Perspectives on healthy aging among Thai elderly: A qualitative study. Nursing & Health Sciences, 14(4), 472-479.

Waldman-Levi, A., Erez, A.B., &  Katz, N. (2015). Healthy aging is reflected in well-being, participation, playfulness, and cognitive-emotional functioning. Healthy Aging Research, 4(8). http://dx.doi.org/10.12715/har.2015.4.8

Williams, K., & Kemper, S. (2010). Exploring Interventions to Reduce Cognitive Decline in Aging. Journal of Psychosocial Nursing and Mental Health Services, 48(5), 42–51. http://doi.org/10.3928/02793695-20100331-03

Wong, P.W.C. et al. (2014). The well-being of community-dwelling near-centenarians and centenarians in Hong Kong a qualitative study. BMC Geriatrics, 14:63

Zorn, C. R. (1997). Factors contributing to hope among noninstitutionalized elderly. Applied Nursing Research, 10(2), 94-100.

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