The current study revealed several important discoveries. First of all, multivariate results detected that life satisfaction was significantly and negatively related to musculoskeletal pain. This corroborates findings with previous studies where life satisfaction was significantly reduced due to musculoskeletal pain (Aboderin & Nanyonjo, 2017; Boonstra, Reneman, Stewart, Post, & Schiphorst Preuper, 2013; Dong et al., 2020). According to studies on pain, the experience itself has negative impact on life satisfaction regardless of the origin of the pain or age group (McNamee & Mendolia, 2014; Silvemark, Källmén, Portala, & Molander, 2008; Stalnacke, 2011) and is commonly associated with adverse repercussions such as pain-related disability, distress, depression, sleep problems, mental and physical comorbidities, poor physical functioning, reduced cognitive performance, greater risk of falling and lower quality of life (Q. Chen, Hayman, Shmerling, Bean, & Leveille, 2011; Chou, 2007; Cimas et al., 2018; Denkinger, Lukas, Nikolaus, Peter, & Franke, 2014; Dragioti, Larsson, Bernfort, Levin, & Gerdle, 2017; Eccleston, 2019; McNamee & Mendolia, 2014; Wang, Pu, Ghose, & Tang, 2018). In addition, musculoskeletal discomfort limits locomotion, self-care difficulties and physical inactivity, which may also lead to social isolation and depression (Blyth & Noguchi, 2017; Keenan, Tennant, Fear, Emery, & Conaghan, 2006). This has greater impact on elderly where maintaining a good social relationship with friends; having easy access to health and economic services and not being isolated from the society and meaningful activities play substantial role in their life satisfaction. Furthermore, the present study also demonstrated that life satisfaction was significantly related to difficulty to perform daily activities, which could be due to musculoskeletal discomforts. In the same vein with previous study, participating in more daily physical activities induced pleasant affect, increase feelings of energy and reduces sense of fatigue (Maher, Pincus, Ram, & Conroy, 2015). The elderly whom were more physically active also feel more competent and have sense of identity (Berg, Hassing, McClearn, & Johansson, 2006; Borg, Hallberg, & Blomqvist, 2006). Absence of social belonging would decrease the ability of a person to avoid negative effects (Simone & Haas, 2013) and subsequently affect their quality of life.
Another important findings was that mental health and health status towards life satisfaction was significantly related. The relationship between psychological health and life satisfaction amongst aged population are well documented where adverse mental health can significantly affects the elderly’s life satisfaction (Ghimire, Baral, Karmacharya, Callahan, & Mishra, 2018; Lombardo, Jones, Wang, Shen, & Goldner, 2018). Our elderly population remained satisfied with their living, despite small extend of mental and emotional problems, such as felt depressed and felt like crying, which corroborates with recent study in China where elderly Chinese population enjoyed higher evaluative well-being despite experiencing depression (Ng, Tey, & Asadullah, 2017). High level of life satisfaction in our elderly participants, perhaps, could be explained by the government’s generous welfare support for the elderlies, such as free medical and health care services, heavily subsidised foods process, housing scheme and monthly BND$250 Old Age Pension allowance for every citizens once they reach aged of 60 (Attorney General Chamber’s, 2014). Moreover, the Brunei national philosophy: the Malay Islamic Monarchy (Melayu Islam Beraja (MIB)), could influenced our elderlies’ perceived life satisfaction. This cultural-religious practices have been inculcated in the Bruneian way of life for generations (Talib, 2002). Every Muslims believed that being ill, suffering from disease and dying were part of life and a test set by God (Allah), thus embracing these hardships with patience, meditation and prayer was regarded as an act of faith (Rassool, 2000). This religious affiliation, therefore, provides barriers for our elderlies from the negative effects of mental or emotional issue, in concordance with study undertaken in Malaysia—a country with the same religion and almost identical cultural and ethnic setup—where religiosity was found to positively associated with elderly’s life satisfaction (Achour, Haj Ali, & Qasem Al-Nahari, 2019). However, it could be argued that our elderlies’ feeling of life satisfaction may not be sustainable throughout their life span. The WHO recognises that the older adults can be vulnerable for mental health disorders which negatively affects their overall health (World Health Organization, 2013). Therefore, continuous surveillance of psychological and emotional issues are warranted.
Finally, our univariate results demonstrated that family support played significant role in influencing the life satisfaction for our elderly population. Numerous studies have found that existing support from family is integral for life satisfaction among the elderly (Pan, Chan, Xu, & Yeung, 2019; Prakash & Srivastava, 2020; Şahin, Özer, & Yanardağ, 2019). Children and relatives form strong support structure for the Malays, and the Chinese community frequently sought support from friends and neighbours (Evans, Allotey, D IMELDA, Reidpath, & Pool, 2018). Family institution in Brunei is an extended family orientation. Within this family, parents, children, grandparents, uncles and aunties commonly live together and assume roles and responsibilities towards helping and supporting each other’s needs (H.-Y. Chen et al., 2012). Furthermore, the fundamental features of MIB emphasise care for elderly which underpins the Islamic code of behaviours and the modesty of the Malay culture of Brunei (Evans et al., 2018). However, our multivariate results revealed that family support was no longer significant after accounting for other factors. One plausible explanation could be that our elderly population eventually become less reliant on their family to continue living satisfactorily, perhaps, due to the growing necessity for them to live independently. Present family support for frail elderly and carers in Brunei has been declining and this downward trajectory could be attributed to increasing numbers of Bruneian who were married at later age, high proportions of female being singlehood and preferences for smaller family size (Ahmad, 2018). Furthermore, as elderly appears to be moving away from traditional family support system, and the availability and legalisation of residential home for elderly, such as nursing home in Brunei, we need to shift our discussion towards integration of community-based support and even technological-based support, as the way forward.
The present study provided comprehensive picture of health domains and life satisfaction of a representative sample of elderly population in Brunei. However, questionnaire-based study is prone to recall and reporting bias. Cross-sectional study would not capture trending and prospective issues. It is strongly encouraged that future researcher investigate this topic from multi-level perspective (individual, community and organisational) and include multi-sectorial public and private actors whose roles increasingly intersects with life of elderly population prospectively, to provide holistic view of elderly life, continuous monitoring and rapid intervention effectively.
In conclusion, our findings showed that life satisfaction of elderly population in Brunei could be explained largely due to musculoskeletal pain, difficulty to perform daily activities, psychological and emotional issues, and family support. The present results contributes to ongoing multi-sectorial efforts to design a comprehensive model of elderly care that provides accurate assessments, monitoring of health and life satisfaction, and rapid and effective intervention to achieve high quality of life.