Older adults around the world have this common plea to “add health to our years” . Investing in adding health to years has significant benefits to all populations. However, the current public-health frameworks to an aging global population have been ineffective – the health of older people is not keeping up with increasing longevity, as shown in marked health status inequities of older adults within countries and around the world [2,3]. Adding extra years to health has major implications for children, youth, adults, and older persons, and it offers great opportunities and possibilities that impact how people live, love, work, play, and relate to one another. These opportunities and possibilities are solely dependent on one characteristic alone: people’s health. Therefore, to experience these extra years of productivity, there is a need to be in good health. The ability to do the things people value and desire will have few limits if they are healthy. Investment in and return on investment in adding health to years in aging should be the goal of every person, family, community, society, and country.
A valuable population group in the society that requires attention to health are the older persons or senior citizens aged 60 years old and above. The world's population is aging. Globally, the population aged 60 and over is growing faster than all younger age groups . Additionally, the Philippines is considered one of the top ten countries in Asia with the fastest growth rate of older adults (60 years and above) . More particularly, Central Visayas, the Philippines' central region, is one of the regions in the country that has the highest population growth rate (i.e., 8.8% increase from 2010 to 2015) . Additionally, the older adult population growth rate in the Central Visayas region has increased from 7.8% in 2010 to 8.2% in 2015 . The increased number of beneficiaries of the region’s Social Pension for Indigent Senior Citizens program (i.e., a sixfold increase from 2011 to 2015 and fourfold from 2015 to 2018) [7,8] confirms the increasing older adult population growth rate of the Central Visayas region of the Philippines. Based on the increasing trend of the elderly, the Regional Development Council of Central Visayas chose to be pro-active in reducing the vulnerability of the older adults through the collaboration with government agencies in strengthening social development policies and developing learning resource centers that would specialize in preserving and sustaining the culture of health care for the older adult population .
Overall Health of Older Adults
Older persons globally contribute to society in diverse ways – through their family, community, and society as a whole. The extent of their contributions to society largely depends on their health. Adding health to years is a goal all living persons at any age could aim for (WHO, 2015). One major challenge in assessing older persons' health is the sheer diversity of health and functional states they experience that are loosely associated with chronological age (WHO, 2015). Diversity, inequity, marginalization, and stereotyping must be addressed to transform a comprehensive global public health response to an active aging world population. Therefore, it is crucial to transform misaligned health systems that serve older adults by clearly and convincingly redefining health and by integrating the conceptualization of "adding health to years" as part of the health systems' strategic framework [10,11].
As part of a person's physiological development, an individual’s physical and psychological functioning is expected to decline as one ages . Knowing that these changes will occur in older persons, there is a need to monitor and anticipate modifications in older persons' lifestyle to address their need for safety . Health is focused on symptom-related and function-related patient-reported outcomes . Hence, we focused on the symptom-related reports (i.e., anxiety, depression, fatigue, sleep disturbance, pain interference, and pain intensity) and the function-related reports (i.e., physical function and the ability to participate in roles and activities) in the current study.
Experience of Abuse of Older Adults
On the profile for elder abuse, the WHO  reported that elder abuse is now recognized internationally as a public health problem, urgently requiring the attention of health care systems, social welfare agencies, policymakers, researchers, educators, and the general public. With a global increase in the elderly population, elder abuse is expected to become an even more pressing problem, affecting millions worldwide. For many older persons, elder abuse is cause for concern, albeit their voices are drowned by poverty, disability, and cultural stereotypes. It is challenging to quantify the extent of elder abuse, neglect, and exploitation because many such cases go undetected and unreported .
Many studies on elder abuse in Asia, especially in China, India, Singapore, Japan, Korea, and South Asia, consider the subject matter taboo, something that should not be discussed outside the confines of the family ; these are culturally constructed barriers to prevention, recognition, and response to elder abuse, in its many forms. It is important to assess the relevance of current tools and resources that older adults, their family members, and front-line caregivers use to resolve this critical issue. In a study of 355 Hong Kong seniors (aged 65 and over), 21 percent of study participants were found to have experienced at least one instance of abuse (predominantly verbal abuse) within the past year . Researchers suspected that the Chinese tradition of preserving the privacy of the family might have contributed to an underestimation and underreporting of elder abuse ..
According to the Coalition of Services of the Elderly  elder abuse in the Philippines remains invisible, underestimated, unreported, and unaddressed. Elder abuse occurs in different settings, yet nothing is being done to stop it and protect the rights of older people . Most cases of elder abuse occur at home, and family members are reported as the main perpetrators. Even older people who witness elder abuse remain silent and uninvolved. The COSE  suggests that elder abuse in the Philippines is an “invisible” problem.
Resilience of Older Adults
Resilience is the ability to bounce back from adversity or circumstances that produce a significant decrease in one's quality of life . As a personality trait, resilience has been defined as a stable quality that allows them to bounce back from adversity and adapt [21,22]. In this capacity, resilience is thought to moderate the effects of stress and act as a protective strength in the face of adversity [23,24,25]. Few studies have been conducted on the resilience of older adults residing in the Philippines. Most studies on the resilience of Filipino older adults have focused on the context of post-disaster coping [26,27]. In a study of older adults residing in an urban community in the northern region of the Philippines, Cuevas et al.  found that continuous employment in old age had a predictive effect in improving resilience despite the experience of abuse. These findings also concur with Kwan’s  study that social support through livelihood promotes Filipino older adults' resilience despite adversities after a natural disaster.
Technology Use of Older Adults
Technology such as mobile phones in older persons is slowly expanding its use. Mobile phones are the means of communication of older persons with families and social networks and a link for calls for assistance if they need help. Studies show increasing acceptability of the use of technology for health purposes [30,31] and motivation to use mobile phones to improve their mental health . Berkowsky et al.  postulate that using technology such as mobile phones among older adults can enhance resilience. Despite preliminary evidence on the increasing acceptability of technology use among older adults, there is a dearth of studies focusing on technology use and its impact on Filipino older adults' health and resilience.
Health, Abuse, and Resilience of Older Adults
Few studies were conducted on the overall health of Filipino older adults focusing on the experience of abuse, their overall health, and resilience (Cuevas et al. 2020; Flores, 2019). Flores (2019) reported that Filipino older persons exposed to abuse were more likely to have low levels of perception of overall health. Cuevas et al. (2020) found a negative relationship between resilience and experience of abuse, even though resilience showed a probability of exposure to abuse (Cuevas et al. 2020). However, the above-mentioned studies were conducted in the Luzon areas (northern areas) of the Philippines. None of these studies was undertaken in the Philippines' Visayas region (central area). Additionally, Cuevas et al.  and Flores  focused on the direct relationships of experience of abuse, overall health, and resilience with selected demographic variables. These studies did not consider the direct and indirect effects of these variables. Additionally, the use of technology and its relationship with significant factors on older adults' health were not explored.
Constantino et al.  also explored the relationships between overall health, the experience of abuse, and resilience among older persons residing in the Pittsburgh, Pennsylvania area. They found that the positive health features such as physical function and social roles increased with education. In contrast, negative health features (anxiety, depression, fatigue, sleep disturbance, pain interference, and pain intensity) decreased as education increased . The same study showed that resilience predicts anxiety and depression . Although Constantino et al.’s  study provides preliminary evidence on the relationships between health, resilience, and abuse, they did not report findings on the indirect effects of health, resilience, and abuse on technology use of older adults. Additionally, the population of focus in the study was older adults of different racial groups residing in the United States .
Based on the gaps in the literature, a study on the Health, Experience of Abuse, Resilience, Technology use, and Safety (HEARTS) of older adults is imperative at redefining the health of older persons more broadly and diversely, including physical function, anxiety, depression, fatigue, sleep disturbance and sleep-related impairments, the ability to participate in social roles and activities, pain interference, and pain intensity. Consequently, it is also imperative to explore the health, the experience of abuse, resilience, technology use, and safety of older persons and their correlations by testing on the moderating and mediating effects of the experience of abuse and resilience on health and technology use. Therefore, we developed three hypothetical models (Figures 1 to 3) to test specific relationships among the variables.
More particularly, we hypothesize that the experience of abuse has a direct effect on health (i.e., physical function, anxiety, depression, fatigue, sleep disturbance, ability to participate in roles and activities, pain interference, and pain intensity) and that resilience moderates the effect of abuse on the health outcomes of older adults (Figure 1). This first hypothetical model (Figure 1) is theoretically supported by studies indicating that older persons who are at risk of abuse are predisposed to behavioral, social, and environmental risk factors that exacerbate pain, anxiety, depression, deterioration of physical health, and sleep [37,38,39]. Additionally, Cuevas et al.  had established that abuse has a negative correlation with the health of Filipino older adults and a negative correlation between resilience and experience of abuse.
We also hypothesize that particular health outcomes, namely the physical function, anxiety, depression, fatigue, ability to participate in roles and activities, pain interference, and pain intensity, have a direct effect on sleep disturbance, and that the experience of abuse mediates between overall health and sleep disturbance (Figure 2). We highlight sleep disturbances and sleep-related impairments among other determinants of health through our second hypothetical model (Figure 2) because sleep is a restorative process. More importantly, sleep acts as the brain’s housekeeper that initiates metabolic clearance by enhancing the removal of potential interstitial neurotoxic waste to restore metabolic homeostasis [41,42]. In older persons, however, sleep is a diminishing commodity. The consequences of sleep disturbances and sleep-related impairments can be health- and life-threatening [43,44,45]. Sleep disturbances and sleep-related impairments are significant public health problems among older adults (60 years and older). Rates of sleep disturbances and sleep-related impairments exceed 20% to 30% in this age group, making it more frequent than for any other age group . Despite this information, there is much to be done in enhancing our understanding of sleep in older persons. Sleep disturbance and sleep-related impairments are among the most common disorders in aging, but they are overlooked as symptoms of other disorders . Hence, our second hypothetical model (Figure 2) is theoretically supported by study findings showing that abuse in older persons affects sleep quality in later life , and that health indicators such as physical activity and depression also predispose sleep disturbance in older persons .
Finally, we hypothesize that resilience has a direct effect on health outcomes of older adults and that technology use mediates the effect of resilience on health (Figure 3). The third hypothetical model (Figure 3) is theoretically supported by how the use of technology facilitates in monitoring health (e.g., remote monitoring), providing health information to help with decision making, and enhancing social support [48,49]. Additionally, a strategy in which technology can enhance older adults' health is by promoting resilience . Although there is evidence on the positive effect of technology use on the resilience of older adults [33, 50] and on health outcomes  the mediating effect of technology use on the relationship between resilience and health remains underexplored.
Aims of the Study
The following are the aims of the study: (1) To assess the HEARTS (Health, Experience of Abuse, Resilience, Technology use [mobile/phone] and Safety) of older adults; (2) To determine the relationships between health indicators (i.e., sleep disturbance and sleep-related impairments, resilience, and experience of abuse); and (3) To assess the difference between technology-use based on health indicators and resilience among older adults. Therefore, we hypothesize the following:
Hypothesis 1. Better health indicators are significantly correlated with the resilience of older adults.
Hypothesis 2. Health indicators are expected to be reduced among older adults who have experienced abuse.
Hypothesis 3. Resilience will moderate the relationship between the experience of abuse and health.
Hypothesis 4. Experience of abuse will mediate between overall health and sleep disturbance and sleep-related impairments.
Hypothesis 5. Technology users (mobile phones) have better overall health and resilience than those who are not technology users.
Hypothesis 6: Technology use mediates the effects of resilience on health.