Predictive Role of Psychosocial Factors in Older Adults Life Satisfaction

Background: The older adults are a part of society whose population is increasing as science progresses and health conditions improve. Social, psychological and behavioral factors will be inuenced on life satisfaction in older adults. We aimed to predictive role of psychosocial factors in life satisfaction older adults. Methods: It was a descriptive-analytical study which has conducted on 679 older adults through convenience sampling from Qom city during 2018. The data were collected using demographic characteristics, life satisfaction, well-being, cognitive status, social support, and daily activities of life. Data were analyzed by SPSS software version 22 and independent t-test, ANOVA, Pearson’s correlation coecient and multiple regression analysis. Results: The mean and standard deviation of older adults age was 70.43 ± 7.62 years. The mean life satisfaction score was 13.77 ± 3.73. The results showed a signicant relationship between job and education with life satisfaction (P <0.001). The results also showed that social support (P= 0.001) and daily activities (P= 0.017) signicantly predict the level of life satisfaction, and the dimensions of health (P= 0.001) and cognitive status (P= 0.007) have a larger share in predicting the satisfaction of older adults life. Conclusion: We found that some parts of life changes in older adults can be predicted with the help of social support, health status, cognitive status, and everyday life activities. Therefore, in order to increase the level of satisfaction of older adults life, it is suggested that the eld of promotion of social support, health status, and cognitive status be provided.

with the level of education, nancial resources, self-assessment of health, receiving nancial support from the children and satisfying their support, staying at home, seeing and visiting neighbors, and inviting them to dinner (11). Didino et al., reported that factors such as income, level of home equipment and anxiety and loneliness are effective on life satisfaction of older adults (12). Bishop et al. described individual access to key and important life sources as factors in uencing life satisfaction. These resources include material, social or personal resources that the older adults have to offer, which can be referred to as the main sources for advancing and maintaining the well-being of individuals. These resources can also help the older adults achieve their personal goals and meet the basic physical and psychological needs (13).
Based on the above and given signi cant impact of social, psychological and behavioral factors on life satisfaction, in this study, we intended to predictive role of psychosocial factors in life satisfaction older adults.

Methods
It was a descriptive-analytical study in 2018. The research population consisted of all older adults living in Qom city. G*Power-3 software was used to calculate the sample size (14). Considering the 95% con dence level, 80% test power, and r = 0.30, 544 were calculated according to the study of Ataollahi et al. (15).To compensate for sample loss and incomplete questionnaires, 20% of the sample size was added to the nal samples and the nal sample size was calculated 679. The calculated sample size is in accordance with the number of samples proposed for Dyadic analysis (16).
Inclusion criteria for the study included speaking ability, satisfaction to participate in the study, age over 60, lack of cognitive problems such as Alzheimer's. Older adults' medical records were used to judge these problems as well as older adults patients' records. Exclusion criteria were dissatisfaction with continued cooperation. Data collection was done in one step using a questionnaire consisting of 6 sections by researchers in public places where the target group was referred. The questionnaires were lled out by well-educated older adults under the supervision of questioners and for low-educated or illiterate elders, questionnaires were completed through an organized interview.

Research Tools
Demographic information questionnaire: The questionnaire included age, gender, employment status, marital status, educational level, income source, number of children and housing status.
Life Satisfaction Index-Z (LSI-Z): This questionnaire has 13 questions, designed in 1969 by Wylie, Wood, and Sheafor. Each of the questions is answered in the form of "I do not know", "agree" and "disagree", and the 2-1-0 system is used the scoring the answers.
In this way, "I do not know" is scored zero; in positive questions, "agree" is scored 2 and "disagree" is score 1 and in the case of negative questions, "disagree" is scored 2 and "agree" is score 1. The total score of life satisfaction is estimated0-26. Obviously, a higher score indicates a higher level of life satisfaction. Regarding the interpretation of the LSI-Z score, ≤12 indicate a low level of satisfaction, 13-21 average satisfaction, and 22≤ high satisfaction (17.18).
In Iran, the validity and reliability of this questionnaire are veri ed in different studies. Taghribi et al. reported the reliability coe cient of the tool through re-test with ICC coe cient as 0.93. Cronbach's alpha coe cient of the present questionnaire was estimated 0.79 (19).
Activities of Daily Living (ADLs): In the present study, the 6-itemversion of Katz was used. This tool includes personal grooming items, eating, dressing, sitting, bathing, and controlling urine and feces. Each item has three options: "dependent" (zero points), "need help" (1 point) and "independent" (2 points).
The overall ADL score is from zero to 12 and each test is ranked "dependent" (0 to 4 points), "need help" (5 to 8 points) and "independent" (9 to 12 points) based on the score it earns. The validity and reliability of this tool have been proven by Katz (20).
WHO (Five) Well-Being Index (1998 version): This scale consists of ve questions that assess the mental status of individuals over the past two weeks in a table. These ve questions with the Likert technique include 6 options of "at all times" (score 5), "most often" (score 4), "slightly more than half of the times" (score 3), "slightly less than half of the times" (score 2), "sometimes" (score 1) and never (0 score).To compute the points, the numbers in the squares are summed up and multiplied by 4. The resulting number ranges from zero to 100, which points to a greater degree of well-being.
Medical Outcomes Survey (MOS): This scale was created in 1991 by Sherborne and Stewart and provides social support received by the subject. The questionnaire, which is a self-report tool, has 19 sentences, and the subject speci es the amount of disagreement or agreement with each of the expressions bya 5point Likert scale (1 point for "never" to 5 points for "always"). The lowest score in this test is 19 and the highest score is 95. To get the overall score, all scores are combined.
The high score of the subject on this scale indicates that the subject has favorable social support. To obtain the score for each sub-scale, it is enough to merge the scores for the phrases associated with each sub-scale. The validity and reliability of this scale have been reported desirable. The reliability of this test has been reported using Cronbach's alpha coe cient in the range of 0.74-0.93 (21).
Abbreviated Mental Test (AMT): This questionnaire contains 10 simple and short questions that measure orientation, focus/attention, short-term memory, and long-term memory, and is used to screen for cognitive impairment including dementia and delirium in the elderly. The short form consists of 10 questions with 10 points, which takes only 3 minutes to complete. This test has been validated in Iran and its scoring is so that the score below 6 is suspected of moderate cognitive disorder, a score of 6 to 8 is suspected of mild disorder, and a score higher than 8 means a lack of cognitive disorder. The intrinsic reliability of the Persian version of AMT is acceptable (Cronbach's alpha coe cient is 0.76), and its external reliability is also desirable (inter-group correlation coe cient is 0.89) (22).
In order to observe ethical considerations in this study, the samples participated in the research project while informing about the goals of the study. Information was also collected without the need to insert personal and in an organized manner.

Data analysis
In this study, data analysis was done using SPSS software version 22 at two descriptive and inferential levels. Descriptive statistics of mean and standard deviation and frequency distribution were used at the descriptive level. Independent T-test, ANOVA, Pearson's correlation coe cient and multiple regression analysis were used at the inferential level. The signi cance level of these tests was considered less than 0.05.
The majority of participants, 91.8% (623), were illiterate and or low-educated. Also, the mean of life satisfaction score in the case group was 13.77 According to independent t-test, life satisfaction was signi cantly correlated with the employment status and education of the older adults (P <0.001), so that the mean of life satisfaction score in the older adults who were employed and had university education was signi cantly higher. ANOVA test results showed no signi cant difference in mean of life satisfaction score in terms of the number of children (P = 0.059) and housing status (P = 0.493) ( Table 1).
There was a positive and signi cant correlation between life satisfaction scores with health status, cognitive status and social support (P <0.001, r = 0.333, P <0.001, r = 0.186, P<0.001, r = 0.291). However, there was no relationship between life satisfaction with age and daily activities of subjects (P = 0.614, r = -0.019, P = 0.564, r = 0.022) ( Table 2). According to the determination coe cient, about 16.3% of the changes in satisfaction with older adults life were due to the four variables mentioned in the regression model. The regression model had acceptable tness (P = 0.001, F = 23.21) (Table 3).

Discussion
The purpose of this study was to determine the predictive role of psychosocial factors in satisfaction of older adults life. The results of this study showed that the majority of the older adults studied had low and moderate life satisfaction, which, in general, did not show favorable conditions. A glance at past studies suggests that the satisfaction of older adults life is not favorable (11,23). However, in some studies, the satisfaction of the older adults with his current life is desirable (12,15). Perhaps this is because the standard LSI-Z questionnaire was used in this study, but in other studies, a researcher-made checklist was used. Also, cultural differences can be the reason for differences in the state of satisfaction with the lives of individuals. In terms of demographic variables, life satisfaction was higher in men than in women. In the study of Hosseini et al., there was a signi cant difference between older adults men and women in terms of life satisfaction (24). However, the results of the study by Ataollahi Ashkevar et al. (15) contradicted this nding.In the present study, married older adults reported a higher living satisfaction than divorced ones or older adults people who lost their spouse. In a study by Botha and Booysen (25), married people had a higher life satisfaction than non-spouses. Cha's study also found more satisfaction with married life (26).
In addition, in the present study, life satisfaction was associated with the employment status of the older adults, so that older adults who were employed had higher satisfaction than other occupational groups.
This nding was consistent with some studies (26-27). However, it was contradictory to the results of the study by Ataollaho Ashkevar et al. (15). In this study, life satisfaction was associated with the educational level of the subjects,so that life satisfaction in people with academic education was signi cantly higher than that in other groups. The ndings of some studies (11,26) were consistent with the present study. However, the results of the study by AtaollahiAshkevar et al. (15) contradicted this nding. Perhaps the reason for the inconsistency is the use of the standard LSI-Z questionnaire in this study and the use of a researcher-made checklist in other studies.
In the present study, there was a signi cant relationship between life satisfaction and the source of income, so that the mean score of life satisfaction in people who had the ability to buy and save was higher than that in other people. Didino et al. (12) also reported that higher income levels for older adults were associated with higher living standards. In study Lim et al. (29), life satisfaction was also associated with the economic situation of the older adults. The results of the study by Ataollah Eshkevar et al. (15) contradicted the ndings of the present study. Cultural differences can be the cause of the difference in the state of satisfaction with the lives of individuals. In this study, life satisfaction was higher in the elderly with fewer children, but this difference was not signi cant. Also, there was no relationship between life satisfaction and housing status in the present study. Findings of the research by Ataollahi Ashkevar et al. (15) were consistent with the present study. However, in studying Lim and colleagues, life satisfaction was associated with housing status (28). In study Li et al., Life satisfaction was associated with staying at children's homes. In Karimi et al. (30), the mean score of life satisfaction in the older adults group living in the home was signi cantly higher than that in other groups.
In the present study, there was no relationship between life satisfaction with age. The study of Ataollahi Ashkevar et al. (15) also reported the lack of effect of the age factor on life satisfaction. However, Angelini et al. (31) stated that with increasing age, the level of life satisfaction increased.
In the present study, a direct and signi cant correlation was found between life satisfaction with health status. The results of some studies (32,33) were consistent with these nding.The results of this study showed a direct correlation between life satisfaction and cognitive status. In the study of Ataollahi Ashkevar et al. (15), unlike the present study, there was no relationship between cognitive status and life satisfaction.
With the destruction of cognitive functions over time, older adults people are increasingly reluctant to perform routine personal activities and become more dependent on others, and in advanced stages of the disorder, they need to be admitted to hospitals and clinics. These conditions reduce self-esteem, anxiety, and depression in them, which affects the quality of life in terms of life satisfaction (34). According to the results of this study, a direct and signi cant correlation was found between social life satisfaction and social support. Li et al. (11) con rmed this nding in their study. Seeman and Adler (10) considered interactions and social support effective on the satisfaction of older adults. Young said in research that family support has increased life satisfaction in the older adults (35). In Iran, Babapour et al. (36) also reported a signi cant relationship between social support and life satisfaction in the elderly. Given that Iran's society is aging and older people are being transferred to institutions more than ever, it can be anticipated that more elderly people will be at risk of falling social support, and maybe their living satisfaction may be reduced. In this research, there was also no relation between daily activities of life and life satisfaction. However, in the study of Good et al., unlike the present study, there was a signi cant relationship between life satisfaction with daily activities of life and the state of independence (37).In the present study, health, social support, daily activities of life and cognitive status were identi ed as lifesatisfaction predictors, so that health, social support and cognitive status had a positive relationship with life satisfaction, but there was a signi cant negative relationship between life satisfaction with the daily activities of life of the people under study. Perhaps the reason for this is the cultural differences in Iranian societies with other societies. In Iranian societies, being dependent on everyday activities as well as social support by others, especially children, increases life satisfaction. Based on the results, it can be argued that by focusing on some of the psychological and social factors mentioned above, the elderly's satisfaction with their lives can be affected. Therefore, it is recommended to plan families in order to determine the causes of life satisfaction reduction with regard to its predictors.
This study had limitations, the most important of which was the low literacy level of the majority of older adults under study, the length of questions in the questionnaire, and the elderly's boredom in responding to them, which prolonged the process of work and reduced the quality of the answers, and there is a widespread negative attitude that many research on the older adults is not aimed at helping them, and only by researchers to advance their own goals. Another limitation of the present study was the crosssectional nature of the study which made it di cult to determine the causal relationship. Therefore, it is advisable to use more lengthy and more comprehensive studies of the factors affecting life satisfaction and the causal relationship. On the other hand, doing this study in a case-control study could provide valuable information to the research team.

Conclusions
Our ndings showed that life satisfaction in the older adults was not desirable. Therefore, the necessity of using solutions to improve life satisfaction in older adults community that is weaker in this category is felt. Social support, health and cognitive status and daily activities of life as well as life satisfaction determinants were reported. Considering that the mentioned factors explained 16.3% of life satisfaction, other studies to identify other factors affecting life satisfaction are needed.

Declarations
Ethics approval and consent participate: Our study was approved by independent Ethics Committee of Ahvaz Jundishapur University of Medical Sciences by Ethics Number: IR.AJUMS.REC.1397.898.
Verbal Consent was obtained from the study participates in this research, and was approved by the independent Ethics Committee of Ahvaz Jundishapur University of Medical Sciences.

Consent for publication: Not applicable
Availability of data and material: Not applicable Competing interests: There are no competing interests for authors.