Study on Life Satisfaction of the Elderly Based on Healthy Aging

The life satisfaction of the elderly is the key to subjective well-being and healthy aging. Many related studies are focused on the affected factors, including health status, economic level, social support, pension mode, social security, and intergenerational support, etc., but few are based on the macro perspective of healthy aging. This study constructed a healthy aging evaluation system with 6 dimensions, including 15 primary indicators and 57 secondary indicators, to evaluate the relationship between healthy aging and elderly life satisfaction. Results showed that the 13168 participants were, mainly, female (53.76%), 80–99 years old (47.99%), lived in rural areas (77.00%), married and living with their spouse (43.70%), and widowed (52.15%). 80.32% lived with household members. 70.37% elderly were satisfied with their lives. Specifically, there was no gender difference in life satisfaction of the elderly (p=0.273), but there were significant differences between groups of urban and rural (p < 0.001), age groups of 65–79 and 80 older (p < 0.001), marriage groups of unmarried and married (p < 0.001), and types of elderly care of living alone and with others (p < 0.001), respectively. Among the six dimensions of healthy aging, healthcare performed best and living environment dimension was the worst, which was an area that urgently needed to strengthen. The odds ratios (ORs) showed that the dimensions of social participation/social equity and economic finance played important roles in the well-being of the elderly. Under the macro background of healthy aging, how to take measures from the micro perspective of the healthy aging evaluation index system and ultimately improve the life satisfaction of the elderly and still needs to be explored in-depth.


Introduction
To cope with global aging, the World Health Organization (WHO) has proposed a Decade of Healthy Aging 2020-2030 to promote the health of more than a billion people aged 60 and over [1]. e Chinese government has learned from and adopted the concept of healthy aging from the WHO, which defines healthy ageing as "developing and maintaining the functional ability to make older people well-being". WHO stressed the need to create a world caring for the elderly, and the health system changed from a disease-based medical model to a comprehensive care model focusing on the needs of the elderly, especially, transportation, housing, social protection and support, urban development, information and communication, education, labor health and long-term care, and other multisectoral collaborative promotion [2]. e aging process is a stage of the life cycle. In some cases, there are significant differences between individuals in the physical and cognitive state of the elderly [3], which leads to the loss of cognitive and physical abilities. Life satisfaction and physical activity are two key aspects of healthy aging [4]. Life satisfaction of the elderly is the concrete embodiment of subjective well-being and healthy aging [5], and the theoretical basis for the development of healthy aging and the implementation of the healthy China strategy in China. Some studies have been used to explain the life satisfaction of the elderly [6]. e main factors that affect the life satisfaction of the elderly are health status, economic level, social support, pension mode, social security, and intergenerational support, etc. One study has shown that life satisfaction and happiness increase with age [7]. e life satisfaction of the elderly living with their family is significantly higher than that of those living alone. Individuals with superior economic conditions and maintaining physical activity and social relations show higher life satisfaction than others [8]. e more chronic diseases the elderly have, the lower their life satisfaction [9]. Although a large number of studies have focused on the life satisfaction of the elderly, there are little studies on how to scientifically and reasonably quantify the healthy aging index and then carry out the life satisfaction evaluation of the elderly based on healthy aging. Based on previous research [10], six dimensions of medical care, health education, living environment, road transportation, social participation and social equity, economy and finance, including 15 primary indicators and 57 secondary indicators, were constructed to objectively evaluate the correlation of healthy aging with life satisfaction of the elderly, which covers 13168 elderly aged 65-117 in 23 provinces and municipalities directly under the Central Government in China, including 6089 males and 7079 females.

Participants.
e participants were drawn from the Chinese Longitudinal Healthy Longevity Survey (CLHLS-2018), aged 65 and above. CLHLS randomly selected samples from 23 representative provincial cities and autonomous regions in China. After deleting the samples with missing and invalid variable values, 13168 effective samples were selected. CLHLS-2018, carried out by the China Center for Disease Control and Prevention and the Research Center for healthy aging and development of the National Development Research Institute of Peking University, aimed to determine the health status and factors of the elderly in many aspects, so as to find potential health problems.

Measures.
e fully aligned polygonal graphical indexing method was used to deal with the situation of healthy aging in different provinces. e fundamental principle of the method is that indices are set up and the higher limit value of these indices is taken as the radius to construct a central inside shape [11]. See the literature for the specific calculation process [12].

Variables.
e process of healthy aging in China includes 6 dimensions, 15 primary indices and 57 secondary indices (Table 1). e data are from China Statistical Yearbook, China Urban Construction Statistical Yearbook and China Health Statistical Yearbook. If S < 0.5, 6 dimensions and 15 primary indices are defined as 0, or is defined as 1.
e life satisfaction and health data of the elderly are from the Chinese Longitudinal Healthy Longevity Survey (CLHLS-2018), based on the questions of "What do you think of your life now". is question has six answers of "very good", "good", "general", "poor", "very poor" and "I do not know". When screening the samples, the participants who answered "I do not know" were eliminated. us, there were only five answers. When calculating the binary regression equation, "very good" and "good" were merged to be defined as 1. e other three were defined as 0. (Table 2), 7079 (53.76%) were female, and 6089 (46.24%) were male. e proportion of males and females was almost equal. e main age groups were 65-79 (39.57%) and 80-99 (47.99%). e vast majority (77.00%) lived in rural areas.

Participants Characteristics. Of the 13168 participants
e marital statuses of the elderly were mainly married and living with a spouse (43.70%) and widowed (52.15%). 10576 (80.32%) lived with household members. e samples were widely distributed in 23 provinces cities and autonomous regions. e four main provinces were Shandong (1668), Guangxi (1603), Jiangsu (1575), and Sichuan (1135).

Relationship between Participant Characteristics and Life
Satisfaction. Table 3 was the relationship between participant characteristics and life satisfaction. Excepting living alone, participants based on demographic variables of residence, age, marriage, and living with others had all higher life satisfaction, accounting for more than 60%. ere were significant differences between groups of urban and rural (p < 0.001), age groups of 65-79 and 80 older (p < 0.001), marriage groups of unmarried and married (p < 0.001), and types of elderly care of living alone and with others (p < 0.001) respectively. However, there was no difference between males and females (p � 0.273). Overall, 9266 (70.37%) participants thought life was satisfactory, dissatisfaction with life accounted for only 29.63%. ere was a significant difference between the satisfied group and the dissatisfied group (p < 0.001).

Life Satisfaction of the Elderly Based on Healthy Aging.
Among the six dimensions of healthy aging (Table 4), the dimension of healthcare performed best (S ≥ 0.5) and the dimensions of the living environment, road traffic, and social participation/social equity were all worse, calculated using the fully aligned polygonal graphical indexing method. For the elderly numbers of life satisfaction under the condition of S ≥ 0.5, the participant numbers who were satisfied with life was the highest in the dimension of healthcare, up to 52.5%. Next is health education, and the living environment dimension has the least number of elder people who were satisfied with life, only is 541(4.11%). us, the dimension of the living environment performed worst and needed to be improved to improve the elderly's satisfaction with their lives. Under the background of healthy aging, how to take measures and ultimately improve the life satisfaction of the elderly still needs to be explored in-depth.

Relationship between Life Satisfaction and Six Dimensions of the Elderly.
is work compared and analyzed six dimensions affecting the life satisfaction of the elderly, such as healthcare, health education, road traffic, social participation/social equity, and economic finance (Table 5). For healthcare, in the life satisfaction group, 6913/9266 (74.61%) were satisfied with healthcare, while in the life dissatisfied  Note. About life satisfaction, "satisfied" means the answer from the participant is "very good" or "good". And "dissatisfied" means the answer from the participant is "general" "poor" or "very poor".

Discussion
Measuring and monitoring healthy aging in countries can promote a common understanding of the types of effective or ineffective initiatives to promote healthy aging [13]. Medical treatment, economy, and finance are important areas to improve the development level of healthy aging. Also, health education, living environment, road transportation, social participation/social equity cannot be ignored. In fact, these indices will comprehensively affect the development level of healthy aging in different regions and the life satisfaction of different elderly groups [14].
Healthcare expenditure is increasingly concentrated on the elderly group [15]. Especially in the period before death, the  medical care expenditure increased sharply [16]. Medical insurance can significantly improve the health status and life satisfaction of the elderly [17]. Health education helps individuals to change unhealthy behavior and lifestyles, so as to reduce or eliminate the risk factors affecting health [18]. Health literacy is negatively correlated with medical utilization and expenditure. Public health strategies promoting appropriate education among patients with low health literacy (LHL) may help to improve health outcomes and reduce unnecessary medical visits and costs [19]. Collective health education activities are helpful to the health recovery of the elderly with complications [20], but the number of comorbidities may interfere with the effect of education and exercise programs [21]. When carrying out healthcare services, we should try to carry out appropriate training for the elderly in order to improve health literacy, cognitive function, and life satisfaction [22]. In addition to good healthcare and education, the living environment is also an important index to measure the urban per capita environmental quality, including the health, comfort, habitability, and happiness of the human settlement environment [23]. For example, an international study using data from 14 cities around the world found that building environmental attributes, including higher living density, good street network, availability of public transport, and more parks, are positively related to the health status of adults [24]. Urban green space improves the environmental quality of urban areas by regulating microclimates, reducing heat stress and atmospheric carbon dioxide, and enhancing biodiversity to improve the physical and mental health of urban residents and the elderly [25]. Furthermore, it is also an important development direction and goal to actively promote healthy aging and build a healthy aging-oriented urban human settlement environment design and assessment system [26].
After retirement, the elderly are likely to replace work travel with nonwork travel, and use more public transport. Relevant data, such as traffic travel need to be added, but they are not found. ere is increasing evidence that walking can prevent various health problems, so as to help the elderly maintain their physical, cognitive independence and life satisfaction [27]. Transportation for the elderly is also an indispensable part of the concept of healthy aging [28]. erefore, aging and transportation mode, aging and traffic safety, aging society, and intelligent transportation are facing challenges in highlighting the livability and humanity of the city, especially in adapting to the retirement life of the elderly. We also need to continuously improve the level of public services through institutional arrangements and give the elderly more opportunities and platforms for fair participation in social development and governance to ensure that the elderly have assessed to due social rights and services. Social participation is a key factor affecting the quality of life of the elderly, which is also a positive response to the construction of an aging environment to enhance the elderly's sense of participation, acquisition, and happiness [29]. Research shows that community environment and social participation have significant positive effects on the health of the elderly. At the same time, social participation plays an intermediary role in the relationship between the interpersonal environment and elderly health [30]. Economic finance is an important indicator of the security dimension of healthy aging. e direct pressure brought by the severe population aging situation is the life care of the elderly, which must be solved by the coordinated development of public financial support, pension supplement, and aging financial development of the government [31]. erefore, the problem of aging is essentially an economic and financial problem, which is a necessary condition for the realization of healthy aging to a certain extent. e limitations should not be ignored. First, due to the limitation of the CLHLS-2018 questionnaire, the life satisfaction of the elderly was evaluated by the one-dimensional question, without the life satisfaction scale. Second, the development index system of healthy aging includes multiple dimensions (see Table 6), and this manuscript only selected six key dimensions.

Conclusions
Our findings demonstrate that healthcare contributes the most to the life satisfaction of the elderly among six dimensions of healthy aging, while the other five aspects are relatively poor and need to be improved, especially the living environment dimension. Healthcare, social participation/ social equity, and economic finance play important roles in the life satisfaction of the elderly.

Data Availability
e research data used to support the findings of this study are available from the corresponding author upon request.

Conflicts of Interest
e authors declare that they have no conflicts of interest.