Factors affecting satisfaction with life

It is generally assumed and expected that satisfaction with life declines as; age increases, increasingly poor health is experienced, there is a concomitant increase in co-morbid chronic health conditions, and functional ability is challenged (Abu-Bader et al; 2002; Asakawa et al., 2000; Bailis et al., 2008; Blace, 2012; Bryant et al., 2002; Chen, 2001; Enkvist et al., 2012; Fagerstrom et al., 2007; Gutierrez et al, 2013; Gwozdz & Sousa-Poza, 2010; Smith et al., 2002). The widely-held stereotypical assumption is that life satisfaction declines with age since physical health, functional ability and mental health decline with increasing age. Rather than being associated with age per se, declining life satisfaction appears to be a consequence of the relationship between age and health.

Studies from different countries however, present mixed findings in relation to the association between satisfaction with life and age. While some have found that low levels of satisfaction with life are associated with old age not all researchers have reached the same conclusions. A small body of international literature suggests that there is no age-related decline in satisfaction with life (e.g. Bowling, Farquhar & Grundy, 1996; Blanchflower & Oswald, 2008; Diener & Suh, 1997; Horley & Lavery, 1995; Smith et al., 1999). More recent studies have found that older people appear to experience at least minimum levels of positive satisfaction with life (Abu-Bader et al.; 2002; Asakawa et al., 2000; Bailis et al., 2008; Baird et al., 2010; Blace, 2012; Bryant et al., 2002; Chen, 2001; Enkvist et al., 2012; Fagerstrom et al., 2007; Frieswijk et al., 2004; Good et al., 2011; Gutierrez et al., 2013; Gwozdz & Sousa-Poza, 2010; Peck & Merighi, 2007; Smith et al., 2002; Stewart et al., 2013), with some findings even

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suggesting that satisfaction with life increases in later life in some populations

(Fagerstrom et al., 2007; Frieswijk et al., 2004). Some of this research also explores the effect on satisfaction with life of declining physical health, functional ability and mental health (e.g., Abu-Bader et al.; Bryant et al.; Chen; Enkvist et al.; Gutierrez et al.;

Gwozdz & Sousa-Poza; Smith et al.) as age increases.

1.4.1.1. Health and satisfaction with life

Research has shown old age to be associated with low levels of health and increased number of longstanding impairments (Bowling, 1995; Ferring, et al, 2004) which are difficult to reverse (Eliopoulos, 2013; Heckhausen & Baltes, 1991) and it has been suggested that old age is characterised by multi-morbidity (i.e., the accumulation of diseases and chronic conditions) (Pinquart, 2001). These characteristics have been shown to be associated with an increase in frailty (Frieswijk, et al., 2004) and a decline in satisfaction with life (e.g., Abu-Bader et al., 2002; Bryant et al., 2012; Chen, 2001; Enkvist et al., 2012; Gutierrez et al., 2013; Gwozdz & Sousa-Poza, 2013; Smith et al., 2002). Paradoxically, when older people with chronic co-morbidities are asked about their health, whether it be in general conversation, at formal health assessment sessions or when asked to rate themselves in a single statement health survey

question, many will answer that they consider themselves to be in ‘good health’ (Choi, 2002; Enkvist et al., 2012; Fagerstrom et al., 2007; Gwozdz & Sousa-Poza, 2010; Smith et al., 2002).

The New Zealand Health Survey (MOH, 2006/2007) found that more than half of 65-74 year old people rated their health as very good or excellent with about 45% of those aged over 75 making the same self-assessment. There appears to be a

considerable gap between objective and subjective ratings of health; between the physical reality and what is perceived by the older person (Hong, Zarit & Malmberg, 2004). It is unclear which of these ratings has the greatest effect on self-evaluation of satisfaction with life among older people.

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1.4.1.2 Functional ability and satisfaction with life

The low levels of functional ability experienced by many older adults, have been associated with co-existing mental and physical health conditions (Oakley, Browne, Wells & Scott, 2006), so that low levels of health (physical and mental) initially might manifest as loss of functional ability in old age. Ferring et al. (2004) observed a

pronounced effect of increased age on functional ability, and identified that low levels of health related to a reduced capacity to perform activities and that both were associated with advanced age. This finding is supported by other studies using objective measures of functional ability (Guralnik & Kaplan, 1989; Wahl, Schmitt, Danner & Coppin, 2010). Functional ability has been defined by Meiner and

Lueckenotte (2006, p.9) as “the capacity to carry out the basic self-care activities that ensure overall health and well-being”. Basic self-care activities, (BADLs and IADLs), can only be carried out if the physical body is able to function at a level that allows the performance of such activity and when psychologically the motivation to do so is present. Lacking the ability to perform ADLs has been considered criteria of un- successful ageing (Rowe & Kahn, 1998). In New Zealand in 2006, three in four (3:4) people aged 65-74 lived at home without assistance; of those aged 75-84, this reduced to one in two (1:2) and only one and one half in ten (1.5:10) of those aged 85+ lived at home without assistance; the majority of people aged 85+ lived at home only with assistance (MOH, 2006/7). Functional ability/capacity has been found to be positively associated with satisfaction with life (Fagerstrom et al., 2007; Gutierrez et al.) when measured by self-report of activities of daily living (both basic [BADL]and instrumental [IADL]) or by dependency. Thus it is assumed that older people experiencing functional decline will consequently experience poorer satisfaction with life compared with those who do not.

1.4.1.3. Mental health and satisfaction with life

Having a high level of good mental health is considered by researchers to be one of the major components of satisfaction with life and successful ageing (Bowling & Dieppe 2005). Over 7% of older adults living in the community in New Zealand experience diagnosed mental illness each year with 9.9% reported as having visited a

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mental health care provider (Oakley, Browne, Wells & Scott, 2006) often with a diagnosis or symptoms of depression. Depression appears to embody the interplay of biological, psychological and social factors in older people (Oakley et al., 2006).

Psychological well-being (self-concept and mental health) can be adversely affected by the experience of pain that is frequently associated with mechanical restrictions to functional ability caused by age-related and other chronic health problems and can increase the incidence of depression in old age (Dew, 1998; Lenze et al., 2001).

The quality of older people’s lives can also be diminished by psychological challenges, such as life regrets (Towers, 2009; Wrosch, Bauer & Scheier, 2005) or experience of loneliness (La Grow, Neville, Alpass & Rodgers, 2012) which compromise their well-being and diminish their ability to be satisfied with life. However, an

emerging body of literature suggests that mental health may not decline as age increases (Alonso et al., 2004; Hudson, 2012; Kessler & Merikangas, 2004; Levinson, Paltiel, Nir & Makovki, 2007; Oakley, Wells & Scott, 2006), A range of adaptive and protective supports and mechanisms. have been suggested to enhance psychological functioning with positive implications for wellbeing. Older people have been found to consider a high level of mental health and cognition together with a high level of physical health to be major components of satisfaction with life and successful ageing (Bowling & Dieppe, 2005).

It has become apparent with the increasing use of subjective measures, that there is a widening gap with age between older people’s perception of their health and functional ability and their measured objective levels (Bowling, 2007; Rapkin &

Schwartz, 2004; Westerman et al., 2008). Such incongruence was found by Ruthig and Chipperfield (2007) to have a large, significant effect on functional well-being among older people who showed high levels of optimism (Van Doorn, 1999) despite low levels of functional ability. Subjective/objective incongruence help to explain the perspective of the older people as they age towards being satisfied with their lives despite the physical and functional losses they experience. The implications of Ruthig and Chipperfield’s findings are particularly relevant to older people with low levels of functional ability as enhanced perception of functional ability was shown to affect perception of satisfaction with life in older people. A similar positive finding was

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reported by Frieswijk et al. (2004) who investigated the effect of an adaptive mechanism (social comparison) on satisfaction with life among frail older people.