The World Health Organization (WHO) defines active ageing as “…
Notwithstanding the established importance of WHO’s concept of active ageing as the leading global policy strategy in Europe [
The concept of active ageing [
According to the WHO document on active ageing [
Active ageing appears as an outcome of different determinants that should allow us to identify particular profiles that are more at risk or, on the other hand, are more favorable to age actively.
Recently, Pruchno et al. [
Previous discussion on the issue of objective versus subjective variables of successful ageing had stressed the idea that the proportion of people claiming ageing successfully is higher than the proportion of people classified as successful agers by objective indicators [
In a different society (Taiwan), Lee et al. [
When examining the concept of ageing well in Europe and Latin America, Fernández-Ballesteros et al. [
McLaughlin et al. [
When explicitly exploring the concept of active ageing, Bowling [
In overall, successful ageing, active ageing, and other related terms as positive ageing or ageing well are viewed as scientific concepts operationally portrayed by a broad set of biopsychosocial factors, assessed through objective and subjective indicators as well as being closely related to lay concepts reported cross-culturally by older persons [
In this paper, we explore the WHO’s model of active ageing [
This paper is part of an extensive Portuguese project on active ageing (DIA project) that includes a cross-sectional survey of adults aged 55+ years living in the community. For this study, subjects were recruited through announcements in local newspapers, local agencies (e.g., seniors clubs), and NGO’s and using the snowball method by which participants indicate other persons with similar conditions. The study ran in different Portuguese regions, including the Madeira and Azores islands. The survey was conducted by trained interviewers, using a structured questionnaire format that entailed demographic, psychological, and social questions. A full description of the assessment protocol (P3A) can be found in Paúl et al. [
The sample comprises 1322 persons aged 55–101 years old. The average age was 70.4 years (SD 8.7 years), and females comprised 71.1% (
The protocol measures the different groups of determinants of WHO’s active ageing model and was elaborated considering an extensive literature review of most common instruments used in Gerontology and previously used the European Survey on Ageing Protocol [
Instruments used for each of the WHO’s active ageing model determinants.
Determinants | WHO (2002) contents | Assessment protocol “P3A” | |
---|---|---|---|
Personal factors | Biology and genetics |
Psychological distress | GHQ-12 [ |
Happiness | QBE/F [ | ||
Cognitive functioning | MMSE [ | ||
Personality | NEO (Costa and McCrae, 1992 [ | ||
Optimism | LOT-R [ | ||
Loneliness | Loneliness scale (Paúl et al., 2008 [ | ||
| |||
Behavior determinants | Smoking |
Pulmonary function | Peak flow |
Strength | Hand grip | ||
Subjective health |
Health and life styles questionnaire (ESAP, Fernández-Ballesteros et al., 2004 [ | ||
Illness | |||
Sleep problems | |||
Subj. physical activity | |||
Vision | |||
Audition | |||
Smoking | |||
Drinking | |||
ADL and IADL | |||
| |||
Determinants of social environment | Social support | Social network |
Lubben scale of social support (Lubben, 1988) [ |
Violence and abuse | |||
Education | Education | Sociodemographic questionnaire | |
| |||
Determinants of health and social services | Health and disease | Life satisfaction |
Inventory of life satisfaction (Fonseca et al., 2011 [ |
Health services | |||
Continuous care | |||
Mental health care | |||
| |||
Determinants of physical environment | Friendly environment | Environment domain of quality of life |
WHOQOL Brief—physical environment subscale (Harper et al.,1998 [ |
Safety houses | |||
Falls | |||
Absence of pollution | |||
| |||
Economic determinants | Wage | Socioeconomic status (National Institute of Statistics) | |
Social security | Income | ||
Work |
Along with socio demographic characteristics (gender, age, education, and income), we analyzed cognitive functioning as measured by the Portuguese version of the Minimental State Examination (MMSE) adapted to illiterate people and to people with very few years of education [
Definition of variables.
Variable | Coding |
---|---|
Subjective health | 1 = very good; 2 = good; 3 = reasonable; 4 = poor; 5 = very poor |
Sleep problems | 0 = no; 1 = yes |
Subjective physical activity | 1 = very good; 2 = good; 3 = reasonable; 4 = poor; 5 = very poor |
ADL | 0 = with difficulties; 1 = without difficulties |
Illness | 0 = none;1 = 1 illness; 2 = 2 illness; 3 = 3 illness; 4 = 4 or more illness |
Psychological distressa | 1 = <9; 2 = |
Happiness | 1 = nothing; 2 = 2; 3 = 3; 4 = very |
Optimisma | 1 = <11; 2 = |
Quality of lifea | 1 = <24; 2 = |
Loneliness | 0 = yes; 1 = no |
Cognitive impairmenta | 1 = <25; 2 = |
Vision | 1 = no specs and very poor/poor vision; 2 = no specs and acceptable vision; 3 = no specs and good/very good vision; 4 = specs and very poor/poor vision; 5 = specs and acceptable vision; 6 = specs and good/very good vision |
Audition | 1 = no device use and very good/good audition; 2 = no device use and acceptable audition/3 = no device use and poor/very poor audition; 4 = use device |
Smoking | 1 = no; 2 = ex-smoker; 3 = yes |
Drinking | 1 = never; 2 = special occasions; 3 = occasionally; 4 = regularly |
Incomeb | 1 = ≤386 €; 2 = 386 €–772 €; 3 = 772 €–1158 €; 4 = >1158 € |
Education level | 1 = no formal; 2 = primary; 3 = 5–8 years; 4 = 9–12 years; 5 = university |
Peak flowa | 1 = <180; 2 = |
Grip strengtha | 1 = <18.3; 2 = |
Familya | 1 = <9; 2 = |
Friendsa | 1 = <5; 2 = |
Confidentsa | 1 = <4; 2 = |
Neuroticisma | 1 = <30; 2 = |
Extraversiona | 1 = <39; 2 = |
Openness to experiencea | 1 = <35; 2 = |
aQuartiles; bby reference to the Portuguese Minimum National Wage in 2006.
The factor structure of P3A was examined by exploratory factor analysis, using principal-components extraction with varimax rotation. For the continuous variables, we used the quartiles in order to standardize the variables and use only categorical variables in the exploratory factor analysis. Exploratory factor analysis was conducted using SPSS 17.0 for Windows.
Confirmatory factor analysis was conducted to test the viability of a hypothesized structure that had been formulated from theoretical considerations and results of the exploratory factor analysis. Confirmatory factor analysis was conducted using AMOS 18 for Windows. Satisfaction scores for each dimension were obtained using factor score regressions generated from the confirmatory factor analysis as proportional weight to combine item scores. Our process of analysis started with the full factors and items, and then we used a nested models approach to test alternative nested structures to test fit improvement. In addition to theoretical and practical considerations, evaluation of fit of model was based on the following goodness of fit criteria, including normed chi-squared
Descriptive analysis (absolute and relative frequencies) was performed for all variables described in Table
The factor structure was examined by principal-components extraction with varimax rotation for the pooled sample ( Factor 1. Health component: this factor comprises five variables (subjective health, sleep problems, subjective physical condition, ADL, and illness) and explained 11.6% of total variance. Factor 2. Psychological component: six variables load heavily of this factor (psychological distress, happiness, optimism, neuroticism, quality of life—environment, and loneliness), which accounted for 11.2% of the total variance. Factor 3. Cognitive performance component: four questions have their highest loadings on this factor (cognitive impairment, vision, income, and education level) and explained 10.6% of total variance. Factor 4. Biological component: this factor comprises only two variables (peak flow and grip strength) and explained 7.7% of total variance. Factor 5. Social relationship component: three variables have their highest loadings on this factor (family, friends, and confidence), accounting for 6.9% of total variance. Factor 6. Personality component: the last factor contains only two variables (extraversion and openness to experience) and explained 6.6% of total variance.
Comparing to the original model [
Factor structure of P3A—exploratory factor analysis.
Questions | Factors | |||||
---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | |
Subjective health |
|
−0.298 | −0.312 | −0.071 | −0.131 | −0.104 |
Sleep problems |
|
−0.154 | 0.152 | 0.133 | −0.114 | 0.260 |
Subjective physical condition |
|
−0.218 | −0.250 | −0.061 | −0.104 | −0.223 |
ADL |
|
0.052 | 0.262 | 0.160 | −0.103 | 0.139 |
Illness |
|
−0.067 | 0.004 | −0.241 | 0.009 | 0.035 |
Psychological distress | 0.437 |
|
−0.101 | −0.084 | −0.112 | −0.005 |
Happiness | −0.265 |
|
0.105 | −0.085 | 0.260 | 0.213 |
Optimism | −0.050 |
|
−0.035 | 0.039 | 0.065 | 0.068 |
Neuroticism | 0.096 |
|
−0.114 | −0.163 | 0.171 | 0.108 |
Quality of life—environment | −0.076 |
|
0.286 | 0.075 | 0.051 | 0.132 |
Loneliness | −0.149 |
|
−0.011 | 0.126 | 0.351 | −0.084 |
Cognitive impairment | −0.096 | 0.180 |
|
0.396 | 0.103 | −0.146 |
Vision | −0.100 | −0.001 |
|
−0.211 | 0.056 | 0.242 |
Income | −0.162 | 0.135 |
|
0.261 | 0.126 | −0.198 |
Education level | −0.098 | 0.133 |
|
0.204 | 0.034 | −0.199 |
Peak flow | −0.044 | 0.157 | 0.295 |
|
0.056 | −0.051 |
Grip strength | −0.266 | 0.098 | 0.042 |
|
0.060 | 0.058 |
Social relations—family | −0.028 | 0.109 | −0.006 | 0.112 |
|
−0.063 |
Social relations—friends | −0.131 | 0.074 | 0.130 | 0.078 |
|
0.269 |
Social relations—confidence | 0.024 | 0.013 | 0.104 | −0.065 |
|
0.011 |
Extraversion | −0.196 | 0.106 | −0.027 | −0.199 | 0.055 |
|
Openness to experience | 0.123 | 0.014 | −0.190 | 0.143 | −0.016 |
|
| ||||||
% of variance explained | 11.6 | 11.2 | 10.6 | 7.7 | 6.9 | 6.6 |
The WHO model and the empirically achieved model.
The achieved model shows that the “health component” is the major factor associated with active ageing and includes self-perception of health, the number of diagnosis, functionality (ADL and IADL), and life style. The second component was “psychological,” which is frequently forgotten in literature, with the exception of psychopathological indicators. In this study, psychological variables include both negative affect (psychological distress, loneliness, and neuroticism) and positive affect (happiness, quality of life—environment, and optimism). The “cognitive performance component” follows in weight showing the importance of wage, education, vision, and cognitive performance. The “biobehavioral component,” comprising respiratory capacity and grip strength clearly shows the importance of biological aspects during the ageing process. “social relationship”, including family, friends, and confidents, illustrates the relevance of social network for the quality of life of old people. Finally, the “personality component” was reduced to extraversion and openness to experience, as neuroticism merged with other psychological variables in the “psychological component.” The profile is quite homogeneous with factors loading between 11.6% and 6.6% and explaining a good amount of total variance (54.6%).
We analyzed the full six-factor model for the 22 variables by using the six item clusters derived from the exploratory factor analysis (presented in Table
Goodness-of-fit statistics for confirmatory factor analysis models of P3A.
Model |
|
df |
|
CFI | GFI |
|
AIC | BCC |
---|---|---|---|---|---|---|---|---|
1 | 701.342 | 194 | 3.615 | 0.891 | 0.936 | — | 819.342 | 822.354 |
2 | 562.046 | 172 | 3.268 | 0.913 | 0.946 | 139.30 | 680.046 | 682.924 |
3 | 557.039 | 155 | 3.594 | 0.908 | 0.944 | 5.01 | 667.039 | 669.597 |
4 | 489.170 | 153 | 3.197 | 0.923 | 0.950 | 67.87 | 603.170 | 605.822 |
The confirmatory factor analyses structure describes adequately the 6 factors reinforcing the adequacy of the proposed model. The various indices of fit presented in Table
Factor structure model for P3A.
Finally, testing the effects of age and gender, only the paths between gender and the “cognition component” and gender and the “Biobehavioral component” were significant (
When we look at the WHO model we can see that apart from the
The
This achieved six-factor model reveals the major contributions the active ageing constructs and goes beyond the successful ageing model that establishes a strict pattern of success by considering that different profiles of old people in different contexts may be classified as active with areas in debt being compensated by more advantaged ones. The relative load of each factor will presumably change in diverse contexts or groups of people, emphasizing the need for different intervention programs to foster quality of life allocating diverse life trajectories, and where, for instance, high income can compensate smaller social networks or optimistic disposition can compensate disability to balance positively the process of ageing. Furthermore, rather than health problems that most of old people have (and/or expected to have in some extent) and some functional limitations, the difference between old people ageing actively or not may vary with the psychological characteristics and status that enable them to cope with ageing related declines, look forward, and keep committed to life. By keeping active in the broader sense of the concept, old people seem to overcome difficulties and keep highly motivated to participate in the social world and engage in healthy behaviors which raise quality of life during the ageing process. As stated recently here, a psychological approach to successful ageing is to have a crucial role in predicting future quality of live in older adults, namely, by maximizing one’s self-efficacy and resilience [
The WHO active ageing model [
This study has two main limitations. The first one regards to the exclusive use of self-rated measures that may had led to an overall “perceived reality” whilst some of the active ageing determinants are to be more objective (e.g., actual presence of social and health services), although Portugal has a NHS with universal and free access and a reasonable coverage of services for the elderly (nursing homes and day centres and a not so extensive service of home care). On this aspect, it is worthwhile mentioning that most of the municipalities have conventional services for old people and that self-report of availability and satisfaction of community health and social services is thought to better reflect the reality and the experience of the present cohort of old people. Moreover, the use of mostly self-reported measures except for cognitive performance and biological parameters, although missing clinical diagnosis and objective environmental variables, constitutes a reliable overview of old people perspective of their own condition and that of the context in which they live. Both these aspects must be considered when interpreting our findings and when conducting further research. The second main limitation has to do with the sampling process (e.g., using announcements in newspapers, senior clubs) which may have resulted in a selection towards the most active older adults. We consider that further studies should comprise different sample selection procedures and a wider coverage of older people towards a more representative overview of the Portuguese population.
The challenge of active ageing is health and independent functioning, whereas psychological variables appear to be highly relevant determining the individual adaptation to the ageing process. In this sense, interventions are to consider the prevention of health problems from adulthood and the increasing of psychological resilience, avoiding loneliness or increasing happiness and subjective wellbeing. Other social and political variables demand different kinds of intervention at a community-based level, namely, rising income and carefully planning the retirement process and pensions regimens.
This paper draws from a research project supported by the Foundation for Science and Technology (FCT), Portugal (Grant POCTI/PSI/56505/2004).