Research progress on subjective well-being and dispositional optimism of the elderly

Li Zhu,Xiang-Shu Cui*

1School of Nursing,Yanbian University,Jilin,China.

Abstract The subjective well-being of the elderly is an integral part of healthy aging.This review introduces the concept of subjective well-being of the elderly and the evaluation tools used,reviews the influencing factors of subjective well-being of the elderly,and summarizes the intervention measures of subjective well-being of the elderly.From the perspective of positive psychology,based on the introduction of the concept and evaluation tools of temperament optimism,this paper reviews the research status of temperament optimism and subjective well-being and the research progress of their correlation,so as to provide a theoretical basis for the intervention to improve the subjective well-being of the elderly.

Keywords:The elderly,Subjective well-being,Dispositional optimism,Overview

Background

The global population aged 65 and over is expected to increase from 9% in 2019 to 16% in 2050.According to statistics,in 2020,China's population over 60 years old accounted for 18.7%,more than 264 million,of which about 190 million were over 65 years old[1].In the face of such a large elderly population,their mental health has aroused great concern of the state and society.Subjective well-being(SWB)is an important component of mental health,which reduces the risk of chronic physical diseases and promotes longevity[2].Positive psychology was put forward by American psychologist Seligman.It focuses on positive personality characteristics and advocates using optimism,initiative,gratitude and wisdom to solve problems[3].The research shows that positive psychological capital can maintain health and improve happiness[4].From the perspective of positive psychology,based on the introduction of the concept and evaluation tools of temperament optimism,this paper reviews the research status of temperament optimism and SWB and the research progress of their correlation,so as to provide a theoretical basis for improving the intervention and health management of SWB of the elderly.

Subjective well-being

At present,there is no unified definition of SWB.Diener believes that SWB is the state of mind presented when individual needs are met[5],and it is mainly an individual's emotional reaction and comprehensive judgment of life satisfaction[6].Based on emotion,Farid and Lazarus defined it as the feeling that individuals feel more positive moral emotions than negative ones[7].To sum up,SWB is an individual's subjective feeling about his or her life quality.

Assessment tools for SWB

Memorial university of newfoundland scale of happiness(MUNSH)

The MUNSH was developed by Kozma[8]in 1980.In 1999,Chinese scholars adjusted the domestic elderly,including positive emotion and negative emotion,with 24 items in 4 dimensions and 3-level score[9].The internal consistency coefficient of this measure is 0.87,with higher scores indicating higher levels of SWB,and is widely used to measure the SWB of adults.

World Health Organization-5 well-being index(WHO-5)

The WHO-5 well being index was developed by Danish scholar Bech.P in 1998 and introduced into Chinese in China in 2004[10].The scale has 5 dimensions;Cronbach'sαis 0.82;the higher the score is,the happier the individual feels.The WHO-5 is one of the most widely used questionnaires to assess subjective psychological well-being and is recommended for measuring well-being in the elderly.It can also be used as a screening tool for depression.

Chinese elderly SWB scale

The SWB scale for Chinese older adults was developed by Chen T in 2009 and contains 23 items with 3 dimensions[11].The scale is scored on a 5-point scale with a Cronbach'sαis 0.936,the higher the score,the higher the SWB.The advantages are that it is based on China national and cultural background and has high reliability and validity.

Subjective well-being scale for Chinese citizen(SWBS-CC)

The SWBS-CC was compiled by Xing ZJ in 2002,which includes 10 dimensions and 54 items,and the scale uses a 6-level scoring method with an internal consistency coefficient of 0.9405[12].In 2003,based on this scale,Xing ZJ compiled the 20-item Simplified Chinese Urban Residents'Subjective Well-being Scale[13],with an internal consistency coefficient of 0.8475,which has the advantage of comprehensive assessment and high validity,and is widely used in the measurement of SWB of urban residents in China.

Research status of influencing factors of SWB in the elderly

If happiness declines as age advances,identifying factors responsible for SWB in the elderly may help in preventing such dropping at this life stage[14].In this section,we review some of the most studied factors,and an in-depth understanding of the impact,results and mechanisms of many factors will help to develop interventions aimed at improving the well-being of the elderly.

Sex and age factors

Many studies have examined whether the sex of the elderly is related to SWB.Lukaschek et al.[15]found that women's low SWB was significantly higher than that of men.Depression,anxiety and sleep problems significantly increased the risk of low SWB,and the impact of living alone on low SWB was only significant in women.Similarly,a Japanese study showed that the factors related to the level of happiness varied between men and women[16].However,Geng,et al.studied 692 elderly people over the age of 65 and showed that gender would not affect the overall level of SWB[17].The reason for this difference may be that the average age of the subjects included in the study is different,the cultural background is different,and the elderly have different standards for defining happiness.Therefore,sex differences in SWB among different groups will be further refined in the future.Medical staff should pay more attention to the elderly who live alone and have negative emotions,and give therapeutic and preventive mental health interventions to encourage the elderly to face life with a positive attitude.

Economic situation

A large number of studies have shown that lower SWB is related to lower income.The elderly with low income and no pension have the highest psychological morbidity and low SWB[18].Other studies have found that lower well-being is associated with lower income[19].Compared with the elderly who report that their disposable income is very sufficient,the elderly who report that their disposable income is very insufficient have a higher risk of lower SWB[20].More explicit research shows that household income is a significant factor affecting the SWB of older adults[21].There are several explanations for why the SWB of the elderly is related to economic conditions.The existing social security system and care services is inadequate to meet the multifaceted need of the growing older population.The long-term economic pressure leads to the unmet health needs of the elderly and the lack of medical resources.Therefore,it is urgent to solve the social and economic disadvantages related to the mental health status of the elderly.Future community intervention should focus on the community material and social environment,make up for the lack of medical resources caused by economic pressure,and promote SWB in later life.

Education level

Among demographic factors,the level of education also affect the SWB of the elderly to vary degrees.Some scholars have found that with age,the correlation between lower education and lower SWB is stronger[20].The main reason is that lower education might led to loneliness in the elderly,which in turn could affect SWB.Access to cultural facilities is positively correlated with the SWB of the elderly[22].Some studies revealed that education was not significantly related to SWB[23],and education may have indirectly affected SWB through health[24].Therefore,medical staff should provide targeted health education according to the individual situation of the elderly.

Activity participation

In addition to being the least active sector of society,older adults are the most sedentary.Physical activity was one of important healthy lifestyles,which could improve physical and mental health,and then affect happiness.A prospective cohort study showed that the number of days people participated in moderate intensity physical activity was positively related to SWB;however,the time spent on high intensity physical activity was negatively related to SWB[25].In another study of 380 60 year old,it was found that actively participating in various activities,such as solo sports and cultural activities,bring higher happiness[26].Similar to the results of previous studies,An,et al.showed that physical exercise is significantly related to life satisfaction and well-being[27].Several explanations for this low level correspondence between activity and well-being can be suggested.First of all,active activities,illness or disability,and maintaining a high level of physical skills are very important for individuals to feel good about themselves and for physical health.Secondly,the decline of physical function in the elderly leads to the reduction of physical activity,which makes it impossible to continue all activities.Since physical exercise can improve the elderly's mental health and reduce anxiety and stress,the elderly should be encouraged to participate in meaningful physical activity.It is suggested that nurses develop effective intervention measures to promote physical activity in the elderly.

Disease related factors

Findings suggest that physical-mental comorbidity negatively associated with SWB among older adults[28].There is a positive correlation between physical function and SWB of the elderly in both high-income and low-income countries[29].A longitudinal study shows that good physical function is the basis of SWB of the elderly[30].Therefore,comprehensive intervention measures should be formulated to target the comorbid physical and mental health of the elderly,delay physical decline,and maintain a high level of happiness in the elderly stage.

Depression and loneliness

Older adults usually suffer from a variety of chronic diseases and disability that increase their vulnerability and reduce their social activities,and affect their quality of life and well-being[31].Depression is a common mental disorder among the elderly,the study showed significant associations between depressive symptomatology,spirituality,and cognitive SWB in older adults[32].Studies have also shown that loneliness significantly predicts subjective and psychological well-being[33].However,some studies have shown that loneliness has nothing to do with the SWB of the elderly[34].Therefore,we should focus on the depressed and lonely elderly and enhance the spiritual overall nursing intervention strategy to improve the SWB of the elderly.

Healthy lifestyle

Health lifestyles were found to be strongly associated with Chinese oldest-old’s SWB[35].A significantly positive effect of healthy lifestyle behaviors on SWB was discovered among Spain sample aged 65 and over as well[36].Meanwhile,empirical analyses supported a significant positive effect of health lifestyle behaviors on individual SWB[37].Prior research documented that being physically active and having lunch,fruits and vegetables daily were positively associated with greater happiness[38].Healthy lifestyle behaviors stimulate the positive emotions of the elderly and reduce the risk of mental health problems.Therefore,medical personnel should incorporate the practice of healthy lifestyle into the mental health promotion plan.

Psychological elasticity

As people age,they are expected to experience adverse life conditions and major life events.These circumstances might have a significant impact on their SWB.Smith and his colleagues describe resilience as one’s ability to bounce back[39],and resilience has been shown to buffer the effect of chronic illness on disability[40].A study shows that psychological resilience is the most powerful predictor of SWB in the elderly and improves Filipino senior citizens’SWB[34].Similarly,Zager's research shows that elasticity can buffer the impact of adverse situations and improve personal SWB[41].Resilience may affect well-being by allowing faster psychological and physiological responses.A study of 41 older adults with chronic illness showed that resilience had a positive relationship with quality of life and well-being[42].Resilience is a resource that can reduce mental illness.It is recommended that medical staff carry out community-based recovery plans,promote the active participation of the elderly,cultivate resilience,and improve their SWB.

Social support

Following findings from Farriol-Baroni V,et al.,the elderly over 60 years old can predict their happiness experience and overall perception of health through perceived social support,indicating the importance of promoting adequate social support and SWB of the elderly[43].Consistent with previous studies,the study have found that there is a positive correlation between social support and subjective well-being of the elderly[44].Inter-generational support refers to the support between the elderly and their children[45],which has a significant direct impact on SWB[46].For the elderly,children are the source of nursing and emotional ties.Research has proved that children's support for the elderly can improve their SWB[47].The main reason is that the elderly,as a special vulnerable group,need more care and help.Some studies have observed that as age increases,social support decreases,and older people,particularly those who live alone,constitute one of the most vulnerable groups that refer to feelings of loneliness[48].With the help of perceived social support,the elderly can prevent or alleviate stress reactions,so as to increase positive emotions,inhibit negative emotions,and prevent the decline of SWB.Therefore,it is emphasized that we need to deeply study the social support of different dimensions,promote support interventions,expand the social network of the elderly to obtain emotional support,and improve the SWB of the elderly.

Coping style

The study found that when the elderly participate in positive coping,their SWB will increase[49].Qin et al.have found that happiness is positively correlated with positive coping and negatively correlated with negative coping[50].Consistent with the research results of Yao RS,et al.,the elderly can experience higher SWB by adopting positive coping styles[51].It is suggested that medical staff should design and implement a comprehensive physical,psychological and social intervention program for the elderly to help improve the coping mode of the elderly,reduce the burden of family and society dependence and nursing needs,so as to promote their SWB.

Research status of elderly SWB intervention

Exercise intervention

Physical activity is beneficial to physical and mental health,while physical activity affects life satisfaction and happiness[52].Sun’s study shows that the SWB of the elderly who participate in educational activities is significantly higher than that of the elderly who do not participate in educational activities[53],indicating that the social participation of the elderly also promote the improvement of their SWB.Zheng Y and Sang ZH took the 90 year old people in the sanatorium as the research object，and the results showed that the subjective well-being of the elderly who received daily exercise care was higher than that of the elderly who did not exercise.[54].After the intervention of yoga and light physical activity therapy for 12 weeks,Gour et al.study’s results show that the physical and mental health and well-being of the elderly have undergone beneficial changes[55].Although aging is an irreversible and inescapable phase of life,physical activity has proved to be a useful tool in tackling age-related problems.It is suggested that medical staff can cooperate across disciplines,formulate exclusive exercise prescriptions according to different elderly groups,encourage communities to carry out various intervention measures,and take physical exercise as a better method to control aging and improve happiness.

Mindfulness therapy intervention

Mindfulness therapy is to consciously focus the individual's attention on the experience of internal and external stimuli at this moment,and to accept these experiences openly and uncritically.Kosugi et al.randomly divided 50 participants into intervention group and control group.The intervention group was given mindfulness cognitive therapy for 8 weeks.The results showed that the score of SWB was significantly improved[56].Some studies have shown that karate combined with mindfulness decompression intervention can improve cognitive function and SWB of the elderly[57].Older adults face many biopsychosocial stressors.There is evidence that an accumulation of such stressors may cause depression[58].Mindfulness therapy has relatively high treatment compliance,and the elderly have a high degree of acceptance and can adhere to it for a long time.In order to verify these findings,it is necessary to conduct multicenter randomized controlled trials,including active control groups and longer follow-up periods.In the future,other interventions can be combined to improve the SWB of the elderly.

Gratitude intervention

Grateful individuals are better at obtaining and making good use of this kind of support and help to promote the elderly to effectively deal with the negative impact of age.Zhang conducted a study on 122 elderly people,and the results showed that gratitude intervention could effectively improve the SWB of the elderly[59].Bartlett and Arpin intervened in gratitude writing practice for the elderly for 3 weeks.The results showed that for the elderly,this intervention could significantly improve personal well-being and alleviate loneliness[60].However,due to the short intervention time,future research should further evaluate the long-term benefits of gratitude training.Gratitude is a positive emotion.Gratitude training is a simple exercise,which can be easily taught to the elderly in the community,and it is worth promoting.

Laughter therapy intervention

Dr.Madan Kataria in India started laughter yoga in 1995,and it is spreading quickly around the world.Research shows that laughter therapy can improve the depression,anxiety,loneliness and sleep of the elderly,and improve their well-being[61].A randomized controlled trial was conducted.The participants divided into laughter yoga combined with self laughter program intervention group and daily life group.After 12 weeks,the intervention effect was measured,and the SWB and mental health scores of participants were improved[62].Laughter is a kind of mild aerobic exercise,which can increase muscle bending and trigger the release of endorphins.The body's natural analgesic chemicals will produce a general sense of happiness[63].Laughter therapy,because of its convenience,no site restrictions and low economic cost,reduces the pressure level of participants,and is worth promoting in communities and elderly care institutions.

Dispositional optimism

Scheier first proposed dispositional optimi sm,and define it as the general expectation of a good outcome in the future.Dispositional optimism is not only a personality trait,but also an individual's internal resource,reflecting the individual's general expectation that the future will have positive rather than negative outcomes when confronted with major problems[64].Optimistic personality includes two factors,optimistic and pessimistic[65],which is relatively stable,and dispositional pessimistic tendency is easier to change than dispositional optimistic[66].

Evaluation tools for dispositional optimism

The Life Orientation Test(LOT)

LOT was developed by Scheier in 1985 based on the direct belief model[67].In 1994,Scheier,et al.revised it into the revised Life Orientation Test revised(LOT-R),which consists of 6 items,including 3 forward questions and 3 reverse questions.The Cronbach'sαis 0.78.The higher the score,the more optimistic it is[68].Lot-R has few items and is easy to be applied.It is not only used to quantify optimism of healthy people,but also widely used to evaluate optimism of many patients with chronic diseases.

Optimism Pessimism Scale(OPS)

OPS is an optimism-pessimism scale developed by Professor Yuan,et al.[69]in China in 2007 based on the LOT-R,which is divided into 2 dimensions of optimism and pessimism,with 11 entries,using a 5-point scale,with internal consistency coefficients of 0.80,0.72,and 0.74 for the total scale,optimism,and pessimism.The advantage is that it is consistent with our cultural background and has good reliability and validity in the elderly population,so it is suitable for assessing temperamental optimism in our elderly population[70].

Current status of research on dispositional optimism in older adults

Dispositional optimism is an important psychological resource.Most researches on dispositional optimism of the elderly focus on the investigation.Weitzer conducted a prospective cohort study,and the results showed that optimism reduced the risk of depression[71].Fogelholm found that optimism and pessimism can improve eating habits,and pessimistic people are more likely to eat unhealthy diet than others[72].Sardella investigated 104 elderly outpatients and found that temperamental optimism was a predictor of health-related quality of life in the elderly[73].In recent years,there are many researches on dispositional optimism among the elderly in China.Wu,et al.conducted a study on the elderly with the same hall,the elderly moving with them,and the empty nests in urban communities,and the results showed that dispositional optimism has an important impact on the psychological resilience of the elderly[74].Fan concluded that increasing the level of optimism and hope in the elderly helps to increase their level of security,which is important for improving sleep quality[75].In addition,Zheng,et al.found that social support not only provides good emotional experience for the elderly,but also increases their optimistic tendency and affects the depression level of the elderly[76].

To sum up,old age is the last cycle of life,and it is also the period when negative events occur frequently,and chronic diseases are an important feature of the elderly.Dispositional optimism is a positive protective factor,which suggests that medical staff should evaluate the optimistic tendency of the elderly and improve their negative emotions so as to improve their mental health.

Correlation between dispositional optimism and SWB in older adults

Chang EC,believes that optimism is an important predictor of psychological well-being[77].Gina and Kyuho also supports this view;temperamental optimism not only plays an important role in the happiness of the elderly[78],but also is beneficial to the happiness of their partners.A cross-sectional survey of 235 elderly people showed that optimism was positively correlated with the positive emotional dimension of SWB and negatively correlated with negative emotions[79].Tang,et al.conducted multiple linear regression analysis using the score of optimistic personality and sub-dimension of the elderly as independent variables[80],and the results showed that the score of optimistic personality and the score of optimism dimension had significant predictive effects on the SWB of the elderly.Niu YB,et al.also supports this conclusion[81].Optimism directly affects the SWB of the elderly.Guo believe that there are many main factors affecting the SWB of the urban elderly[82],and optimism factor,as a psychological capital,has a significant effect on the SWB of the elderly.

In conclusion,there have been many studies on the relationship between temperament optimism and SWB of the elderly.The elderly with a high degree of optimism have good expectations for their own experience,which has a positive impact on the SWB of the elderly.

Summary

This paper summarizes the concept,evaluation tools,influencing factors and intervention measures of SWB of the elderly.Based on positive psychology,this paper reviews the research status of temperament optimism and SWB and its correlation.Cultivating the tendentious optimism of the elderly is of great significance to their mental health.Community medical staff should pay attention to the SWB of the elderly,cultivating and developing the optimistic personality of the elderly.In the context of the accelerated development of population aging,it is of great practical significance to maintain the physical and mental health of the elderly and realize active aging.Therefore,in the future nursing research,we should study the correlation between them more deeply and widely,and formulate scientific nursing intervention measures to help the elderly to improve their psychological state and the level of SWB.