Download Factors Influencing the Meaning in Life in the Old Age

Indian Journal of Science and Technology, Vol 8(25), DOI: 10.17485/ijst/2015/v8i25/80269, October 2015
ISSN (Print) : 0974-6846
ISSN (Online) : 0974-5645
Factors Influencing the Meaning in Life in
the Old Age
Su-Jin Lee1, Ok-Hee Ahn2* and Hye-Gyeong Cha3
Department of Nursing, Kunjang College, Kunsan-si, Jeollabuk-do - 573709, Republic of Korea;
[email protected]
2
Department of Nursing, Woosuk University, Wanju-gun, Jeollabuk-do - 565701, Republic of Korea;
3
Department of Nursing, Namseoul University, Cheonan-si, Chungcheongnam-do - 331707, Republic of Korea
1
Abstract
Purpose: This study purpose is to survey community-dwelling elders’ level in the meaning of life, to identify factors
influencing their meaning of life holistically from the physical, psychological, social, and spiritual aspects, and to provide
basic information for developing intervention programs with strategies to enhance community-dwelling elders’ meaning
of life. Methods: This study is a descriptive research designed to investigate the influencing factors on the meaning in life
among community-dwelling elders. The participants were 306 communicable elders (Age≥65). Data collected from April
to October 2013 were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients, and stepwise
multiple regression. Results: There were significant differences in the meaning in life between gender, age, residential area,
educational level, employment status, extra-occupational activity, marriage status, family living arrangement, relationship
with people living together, living type, monthly allowance, welfare center visiting times. Significant correlations were
found between health promotion behavior (r=.648), social supports (r=.672), self-transcendence (r=.300) and loneliness
(r=-.698). Significant predictors of the meaning in life were loneliness, health promotion behavior, subjective health,
self-transcendence, social support, vocation status, and family living arrangement. Conclusion: The results of this study
suggest that it is needed to develop integrative intervention program that can promoting the meaning in life and reduce
the loneliness
Keywords: Elder, Loneliness, Meaning in Life
1. Introduction
Contemporary society is experiencing the rapid aging of
the population as a result of the development of medicine
and science and consequent extension of life expectancy.
According to the 2013 Korean National Housing Census,
elders aged over 65 occupy 12.2% of the whole population,
and along with accelerated aging, the ratio is expected to
reach 24.3% in 2030 and 37.4% in 20501.
People in their old age, which is the last developmental
stage of life, may go through developmental crises.
Psycho-sociologist Erikson divided people’s development
into eight stages, and said that each stage has its own crises
and tasks to be experienced and overcome. The task to be
achieved in the last stage of life is ego integration, which
is looking back the past life, accepting the life without
* Author for correspondence
regret, and even admitting death peacefully. However,
those in their old age experience poor health resulting
from physical and physiological declines, and going
further, they suffer retirement and the loss of roles and
social associations. As a result, elders at this stage often
think that their lives are meaningless and complain of low
self-esteem, loneliness, isolation, etc2,3.
In4, recognized the psychological state of uselessness,
malaise, loneliness, anxiety, nihility and emptiness coming
from the loss of the meaning of existence, meaning in
life, and sense of purpose, and named the psychological
state ‘existential vacuum’. In5 surveyed elders’ Meaning
in life, and reported that 63.3% of the participants were
in existential vacuum and only 4.2% discovered a clear
Meaning in life. In6, who analyzed the relationship
between the Meaning in life and death, reported that
Factors Influencing the Meaning in Life in the Old Age
elders with a solid Meaning in life were less likely to die
than those without. These studies suggest the necessity
of continuous research for supporting elders to find and
solidify their Meaning in life.
The Meaning in life is implementing the true essence
of man in order to exist as a philosophically genuine
human, and searching for significances in the present and
past life with the belief that one’s own life is valuable and
meaningful in association with the world where he/she
belongs3,7,8.
To help elders find or refine the Meaning in life, first of
all, we need to identify factors that may influence elders’
Meaning in life.
Although previous studies are explaining influential
factors related to the Meaning in life at various
developmental stages3,7,9-11, not many of them are dealing
with elders’ Meaning in life in a way of integrating their
physical, psychological, social, and spiritual aspects. Thus,
this study aimed to survey the meaning in life level among
elders living in an area, to examine related variables
from the holistic aspect, and ultimately to provide basic
information for strategies to promote elders’ Meaning in
life.
•
•
2. Method
2.1 Design of the Research
This study was a descriptive research that investigated
elders’ Meaning in life level and factors influencing the
level.
2.2 Subjects
The subjects of this study were elders who were living in J
Province, Korea, aged over 65, were able to communicate,
and understood the purposes of this study and gave a
written consent to participate in the research, and 306
questionnaires were used as valid data for this study. The
required sample size was estimated using G*Power 3.1.
With significance level 0.05, power of test 0.95, effect
size 0.15, and the number of predictors 7, the minimum
required sample size was 153.
2.3 Measurements
• The Meaning in life level was measured with Elderly
Meaning In Life (EMIL) developed by12. This measurement consists of 37 questions on a 4-point Likert
scale from ‘Not at all’ (1) to ‘Absolutely yes’ (4), and its
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•
•
total score range is 37-148. A high score means a high
Meaning in life level, and ten reverse questions were
reversely converted. A Meaning in life score of 104 or
lower indicates that the subject is losing the Meaning
in life and in an existential vacuum state, and a score
of 105-117 indicates that the subject has not found
a clear Meaning in life and is pursuing the Meaning
in life. Also, a score of 118 or higher means that the
subject has discovered a clear Meaning in life. The reliability (Cronbach’s α) of this measurement was 0.91
in the study of12 and 0.90 in this study.
Health promotion behavior was measured using
the measurement prepared by13 based on the questionnaire on Korean elders’ health behavior developed by14 and adding contents related to eating life,
drinking, weight, smoking, exercise and sleeping,
which were found to be related with health level in
the cohort analysis of Alameda County15. This measurement consists of 22 questions on a 5-point Likert
scale from ‘Not at all’ (1) to ‘Absolutely yes’ (5), and
the total score range is 22-110. A high score means a
high level of health promotion behavior. The reliability (Cronbach’s α) of this measurement was 0.95 in13
and 0.87 in this study.
Loneliness was measured with Korean-version RULS
prepared by16 through translating the Revised UCLA
Loneliness Scale (RULS) developed by17 and testing
its reliability and validity. This measurement consists
of 20 questions on a 4-point Likert scale from ‘Not
at all’(1) to ‘Yes often’(4), and the total score range is
20-80. A high score means a high level of loneliness.
In the measurement, ten items are positive questions
and the other ten negative questions, and the scores of
positive questions were reversely converted. The reliability (Cronbach’s α) of this measurement was 0.93 in
16
and 0.90 in this study.
Social support was measured using the Multidimensional Scale on Perceived Social Support (MSPSS)
developed by18 and translated by19. This measurement
consists of 12 questions on a 5-point Likert scale from
‘Almost not’ (1) to ‘Almost yes’ (5), and the total score
range is 12-60. A high score means a high level of
social support. The reliability (Cronbach’s α) of this
measurement was 0.8919 and 0.96 in this study.
Self-transcendence was measured using questions
on self-transcendence in the Temperament and
Character Inventory (TCI) for adults developed by20
and translated by21, and its contents include creative
self-forgetfulness, self-consciousness, oneness with
all things in the universe, spiritual acceptance, and rational materialism. This measurement consists of 15
Indian Journal of Science and Technology
Su-Jin Lee, Ok-Hee Ahn and Hye-Gyeong Cha
questions on a 5-point Likert scale from ‘Not at all’
(0) to ‘Absolutely yes’ (4), and the total score range is
0-60. A high score means a high level of self-transcendence. The reliability (Cronbach’s α) of this measurement was 0.9321 and 0.95 in this study.
2.4 Data Collection Method
Data were collected during the period from the 3rd
to 26th of August, 2013. For the questionnaire survey,
visiting nurses were recruited as research assistants, and
before conducting the survey, they were educated by the
researcher on the purpose of research, the contents of
the questionnaire, and the survey method. Whether the
questions in the questionnaire were asked in the same
expressions to the subjects and whether the subjects’
answers were marked correctly on the answer sheet were
tested, and differences among the research assistants and
between the research assistants and the researcher were
examined and corrected. The trained visiting nurses met
each subject, explained the purposes of research, got
his/her written consent, and then conducted the survey.
Elders who were able to do self-reporting answered the
questionnaire by themselves, and for those who had
difficulty in self-reporting, the research assistant read and
explained the questions slowly and marked their answers
on the answer sheet. It took about 20-30 minutes for each
to finish the survey. A total of 320 questionnaires were
recovered, but with 14 of them excluded for incomplete
answers, 306 were used as valid data in the analyzes.
2.5 Ethical Considerations for the Subjects
Before it was started, this study was approved by the
Institutional Review Board of W University Oriental
Medicine Hospital (IRB No.: WSOH IRB 1307-03)
for the ethical protection of the subjects. The subjects
were given explanations about the purposes of research
and informed that they could drop out anytime in the
middle of research and private information would not be
collected, and only community-dwelling elders who gave
a written consent voluntarily were included in the survey.
A gift was presented to each subject after the survey.
2.6 Data Analysis
Collected data were analyzed using SPSS/WIN 20.0.
Descriptive statistics was used to analyze the subjects’
general characteristics, Meaning in life, health
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promotion behavior, loneliness, social support, and
self-transcendence. T-test and one-way ANOVA were
used to analyze differences in the Meaning in life, health
promotion behavior, loneliness, social support, and
self-transcendence according to the subjects’ general
characteristics, and Scheffe’s test was used as a posthoc
test. The correlations among the research variables were
analyzed with Pearson’s correlation coefficient. Also,
stepwise multiple regressions were performed to identify
factors influencing the subjects’ Meaning in life.
3. Results
3.1 Meaning in Life According to General
Characteristics
The general characteristics of the subjects are shown in
Table 1. Of the subjects, 15.0% were male, and 85.0%
were female, and 44.4% of them were at the age of 6574. Also, 49.7% were unschooled, and 32.4% were
elementary school graduates, showing that their academic
qualification was generally low. As to religion, 31.7% were
Christians and 43.5% were unbelievers. Moreover, 88.2%
were unemployed, and 65% were bereaved or divorced
and living alone and 35% were living with a spouse. As to
household type, 43.5% of the subjects were of one-person
household, and 27.8% were of elderly-couple household,
showing that the percentage of elderly-couple households
was relatively low. The subjects’ subjective health status
was ‘Poor’ in 35% and ‘Good’ in 24.8%.
Table 1 shows the Meaning in life level showed
statistically significant differences according to the
subjects’ gender (t=2.392, p=.017), age (F=4.166, p=.016),
academic qualification (F=11.256, p<.001), occupation
(t=4.130, p<.001), marital status (t=3.337, p=.001), and
household type (F=4.656, p=.003). Specifically, the level
was 104.91 in the male elders and 100.25 in the female
ones, so the male elders’ Meaning in life level was
statistically significantly higher than the female ones’.
According to age, the level was 102.57 in those aged 6574, 100.59 in 75-84, and 96.00 in 85 or older, showing that
the Meaning in life level decreased significantly with the
increase in age. According to academic qualification, the
Meaning in life level was lowest as 97.28 in unschooled
elders and was 108.43 in high school graduates, showing
that the Meaning in life level was significantly higher in
those with high academic qualification. According to
Indian Journal of Science and Technology
3
Factors Influencing the Meaning in Life in the Old Age
Table 1. Meaning in Life according to General Characteristic (N=306)
Characteristics
Categories
Gender
Male
Female
Age(year)
65-74 a
75-84 b
≥85 c
Education
No education a
level
Elementary school b
Middle school c
≥High school d
Religion
Protestant
Catholic
Buddhism
None
Other
Occupation
Yes
NO
Marital state
Married
Other
Living
Spouse, Family living a
arrangement
Nonspouse, Other living b
Living with their spouse c
Living alone d
subjective health Very gooda
Goodb
Moderatec
Badd
Very bade
p<.05 **p<.001
n(%)
046(15.0)
260(85.0)
136(44.4)
135(44.1)
035(11.4)
152(49.7)
099(32.4)
032(10.5)
023(7.5)
097(31.7)
022(7.2)
047(15.4)
133(43.5)
007(2.3)
036(11.8)
270(88.2)
107(35.0)
199(65.0)
026(8.5)
062(20.3)
085(27.8)
133(43.5)
013(4.25)
067(21.9)
108(35.30)
098(32.03)
020(6.54)
Meaning in Life
M ± SD
F/t(p)/scheffe
104.91±10.31
2.392(.017)*
100.25±12.50
102.57±12.88
4.166(.016)*
100.59±11.62
a>c
096.00±11.32
097.28±10.64
11.256(<.001)**
103.23±11.97
c,d>a
105.91±15.22
108.43±11.92
101.77±12.77
1.860(.117)
097.86±14.20
104.51±12.09
099.72±11.29
098.57±15.99
108.69±10.87
4.130(<.001)**
099.91±12.12
104.09±12.26
3.337(.001)*
099.26±12.00
102.88±9.76
4.656(.003)*
100.27±11.23
c>d
104.61±12.67
098.54±12.46
112.00±11.88
17.544(<.001)**
107.94±11.77
a>d,e
101.36±11.06
095.93±10.85
092.70±10.32
*
employment status, the level was 108.69 in employed
elders, significantly higher than 99.91 in unemployed
ones. According to marital status, the Meaning in life
level was significantly higher in married elders with a
spouse. According to household type, the Meaning in life
level was lowest in elders of one-person household, and it
was higher as 104.61 in those of elderly-couple household
than in those living with other family members. Also,
the differences were statistically significant. The Meaning
in life level was not statistically significant according to
religion (Table 1).
3.2 M
eaning in Life, Health Promotion
Behavior, Loneliness, Social Support,
and Self-Transcendence
Table 2 shows the level of Meaning in life, health
promotion behavior, loneliness, social support, and selftranscendence of the subjects. The mean level of meaning
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in life the subjects of this study was 100.95±12, the lowest
score was 67, and the highest score was 142. The mean level
of health promotion behavior was 81.18±11.14, the lowest
46, and the highest 110. The mean level of loneliness was
43.34±8.66, the lowest 21, and the highest 72. The mean
level of social support was 43.31±8.76, the lowest 18, and
the highest 60. The mean level of self-transcendence was
24.37±11.21, the lowest 0, and the highest 60.
Table 2. Meaning in Life, Health promotion behavior,
Loneliness, Social support, Self-transcendence
Variables
Meaning in Life
Health promotion behavior
Loneliness
Social support
Self-transcendence
Range
37-148
22-110
20-80
12-60
0-60
M±SD
100.95 ± 12.29
81.18 ± 11.14
43.34 ± 8.66
43.31 ± 8.76
24.37 ± 11.21
Min
67
46
21
18
0
Max
142
110
72
60
60
Table 3 shows a Meaning in life score of 104 or lower
Indian Journal of Science and Technology
Su-Jin Lee, Ok-Hee Ahn and Hye-Gyeong Cha
indicates an existential vacuum state in which the subject
is losing the Meaning in life, a score of 105-117 means
that the subject has not found a clear Meaning in life and
is currently pursuing the Meaning in life, and a score of
118 or higher means that the subject has discovered a
Meaning in life. In this study, 194 (63.4%) of the subjects
were at the stage of losing the Meaning in life, 86 (28.1%)
at the stage of pursuing the Meaning in life, and 26 (8.5%)
at the stage of having discovered the Meaning in life.
Table 3. Meaning in Life According to Phases
Variables
Range Frequency Percentage Min Max
Losing the Mean- ≤104
194
63.4
067 104
ing in Life
Pursuing the
105-117
86
28.1
105 117
Meaning in Life
Discovered the
≥118
26
08.5
118 142
Meaning in Life
3.3 C
orrelations between the Meaning in
Life and Major Variables
The results of analyzing the correlations between the
subjects’ Meaning in life level and other influential factors
are shown in Table 4. The Meaning in life level was in a
significant negative correlation with loneliness (r=-.70,
p<.001), and in a significant positive correlation with
health promotion behavior (r=.65, p<.001), social support
(r=.67, p<.001), and self-transcendence (r=.30, p<.001).
That is, the Meaning in life level increased statistically
significantly when the loneliness level was low and when
the levels of health promotion behavior, social support,
and self-transcendence were high.
3.4 Factors Influencing the Meaning in Life
In order to identify factors influencing the subjects’
Meaning in life as a dependent variable, this study
conducted stepwise multiple regression analysis using
health promotion behavior, loneliness, social support,
and self-transcendence, and general characteristics
such as subjective health status, employment status, and
household type as independent variables. Employment
status and household type were included in the regression
equation as dummy variables. Linearity among the
variables was confirmed through matrix plot graphs,
and the hypotheses of regression analysis were tested
through the auto-correlation of the dependent variable
and multicollinearity among the independent variables.
According to the results, Durbin-Watson statistic was
1.768, showing that there was not a major problem in
the independence of the error terms. The tolerance
limit of each variable was 0.363-0.950, higher than
0.1, and VIFs were 1.000-2.755, lower than 10, so the
problem of multicollinearity was not observed among
Table 4. Correlation among Variables
Meaning in Life Health promotion behavior Loneliness Social support
r (p)
r (p)
r (p)
r (p)
Meaning in Life
1
Health promotion behavior
.65 (<.001)**
1
Loneliness
-.70 (<.001)**
-.58 (<.001)**
1
Social support
.67 (<.001)**
.68 (<.001)**
-.73 (<.001)**
1
Self-transcendence
.30 (<.001)**
.27 (<.001)**
-.17 (.002)*
.23 (<.001)**
Self-transcendence
r (p)
p<.05 **p<.001
1
*
Table 5. Factors Influencing Meaning in Life
Constant
Loneliness
Health promotion behavior
Subjective health
Self-transcendence
Social support
Occupation1
Live together2
B
41.873
00.525
00.268
-01.665
00.130
00.200
02.958
02.055
SE
4.574
0.074
0.055
0.498
0.040
0.081
1.382
0.982
β
0.370
0.243
-0.132
0.119
0.143
0.078
0.075
t (p)
9.154(<.001)**
7.108(<.001)**
4.856(<.001)**
-3.346(.001)*
3.269(.001)*
2.461(.014)*
2.140(.033)*
2.092(.037)*
adj R²
0.485
0.575
0.598
0.612
0.619
0.623
0.628
F= 72.408, p<.001
p<.05, **p<.001, Occupation1 : yes, live together2 : Living with their spouse
*
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Indian Journal of Science and Technology
5
Factors Influencing the Meaning in Life in the Old Age
the independent variables. Also, the normality and
equivariance of residuals were satisfied. With these
conditions, multiple regression analysis was performed.
Table 5 shows the subjects’ Meaning in life level
was affected significantly by health promotion behavior
(β=0.243), subjective health status (β=-0.132), selftranscendence (β=0.119), social support (β=0.143),
employment status (β=0.078), and household type
(β=0.075) (F=72.408, p<.001). Loneliness was the most
influential variable with explanatory power of 48.5%,
and the total explanatory power of loneliness, health
promotion behavior, subjective health status, selftranscendence, social support, employment status, and
household type was 62.8% .
4. Discussion
This study was conducted to analyze elders’ Meaning
in life level and factors influencing the level. In this
study, loneliness was found to be the most influential
factor for elders’ Meaning in life, which was followed
by health promotion behavior, subjective health status,
self-transcendence, social support, employment status,
and household type. These variables explained 62.8% of
the variance in the Meaning in life, and loneliness alone
explained 48.5%. Loneliness is an emotion that people
experience when they lack in personal relationships22, and
it is experienced by a large number of people regardless
of age. Loneliness experienced in childhood, adolescence
and adulthood is usually temporary or lasts only for a
short period23, but loneliness experienced in the old age is
a much riskier phenomenon and a common type of stress
causing physical diseases and psychological problems to
elders24,25. In this study, the subjects’ level of loneliness
was 43.34 point, slightly lower than 44.7 point reported
by3, but higher than 41.3 point in the study of26 on livingalone female elders. These differences are probably
because environments for exchanging social influences
were different among community-dwelling elders, livingalone female elders, and elders participating in various
activities such as welfare center programs or volunteer
services.
Loneliness showed a negative correlation not only
with the Meaning in life but also with social support,
health promotion behavior, and self-transcendence. This
suggests the need of strategies to mitigate loneliness by
raising the levels of social support, health promotion
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behavior, and self-transcendence to uplift elders’ Meaning
in life level. Particularly because social support is helpful in
reducing elders’ powerlessness27, improving their quality
of life28, and easing their sense of isolation or loneliness23,
and elders regard social relationship as a more important
factor than physical health29, it is necessary to develop
and execute various programs for expanding elders’ social
network.
In this study, the subjects’ Meaning in life level ranged
between 67-142 point, and the mean score was 100.95
point, which is 68.21 point out of 100 points and slightly
higher than the medium. This score corresponds to the
stage of losing the Meaning in life, and is similar to 67.84
point reported by5. In30 that compared the Meaning in life
between hospitalized and ordinary elders, however, the
Meaning in life level was 66.02 point in hospitalized elders
and 68.75 points in ordinary elders, and in the study of3
with elders using welfare centers, their Meaning in life
level was 71.49 point, higher than that in this study with
community-dwelling elders. What is more, the subjects’
Meaning in life level in this study was lower than 73.11
points in31 study with middle-aged subjects and 74.75
points in the study of32 with adolescents. These differences
in the Meaning in life score are believed to come from the
subjects’ background variables including age. That is, the
Meaning in life level was lower in elders aged over 85 than
in those aged 65-74, and according to subjective health
status, it was significantly lower in those who answered
“Poor” than in those who answered “Good.” Furthermore,
the level was lower in those without a spouse due to
bereavement or divorce than in those with a spouse, and
it was much higher in those “Living with a spouse” than
in those “Living alone.” These results are consistent with
previous reports3,8,9. That is, elders living alone, those
without a spouse, and those whose physical health status
is poor may spend their old years full of regrets and
complaints, and in order to help these elders losing the
Meaning in life, namely, falling in an existential vacuum
state find the Meaning in life, it is necessary to expand
social network and, furthermore, to develop programs for
finding and implementing the values of life according to4.
According to general characteristics, what is more, the
Meaning in life level was significantly higher in employed
elders than in unemployed ones. Employed elders’ average
meaning in life score was 108.69 point, which corresponds
to the stage of pursuing the Meaning in life. This is
consistent with the report of3 that the Meaning in life level
Indian Journal of Science and Technology
Su-Jin Lee, Ok-Hee Ahn and Hye-Gyeong Cha
was higher in elders who were participating frequently in
welfare center programs. Because the Meaning in life is
in a high correlation with social support, it is necessary
for various areas and classes to pay attention and
consideration to elders so that they may continue selfefforts to find the Meaning in life and achieve values of
life through social activities such as works, welfare center
activities, volunteer services, various meetings of sameage people, etc.
In conclusion, loneliness was found to be the most
influential variable for elders’ Meaning in life, and also
health promotion behavior, subjective health status, selftranscendence, social support, employment status, and
household type were identified as influential variables to
be considered. These findings suggest that priority should
be given to interventions for loneliness to enhance elders’
Meaning in life level. Moreover, policies related to elders’
welfare centers should be promoted actively for providing
elders with social support through active welfare services,
elderly employment programs, companion services, etc.
for community-dwelling elders. In addition, logo therapy
for elders’ discovery of a Meaning in life, sports-for-all and
public health education activities for health promotion,
programs for forming and expanding social network, etc.
may be utilized as direct and indirect interventions for
upgrading elders’ Meaning in life.
5. Acknowledgment
This paper has complemented and modified the master
thesis of the first author Su Jin Lee.
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