This cross-sectional study was conducted as part of 'The Active
Aging Project – Istanbul', funded by the Istanbul Greater Municipality.
One hundred and thirty-three residents of the Municipality's Darulaceze
Institute (48 females and 85 males, mean age 73.9 ± 8.0 [range: 60–90
yrs]) took part in the study. Elderly citizens with functional
disabilities and/or independent in ADL are accepted by the Institute,
which is located in Istanbul, the largest city in the country with a
population of 10,072,447, constituting 16.02% of the total population,
and has the largest bedding capacity of all such institutions in the
country, as well as the largest professional staff including
physicians, physical therapists, social workers, psychologists, nurses
and nursing assistants and non-professional staff. Darulaceze Institute
can be defined as 'Elderly Care and Rehabilitation Centers' according
to institutional care system for elderly.
The following were the inclusion criteria for our study:
1. a stable medical condition;
2. not being bedridden or in a wheelchair;
3. independence in performing daily living activities (independence
in walking indoors/outdoors, climbing up stairs, doing self care
activities including taking a bath, feeding, dressing/undressing, were
evaluated by self-reporting),
4. sufficient mental capacity and cognitive function to learn and retain new information;
5. willingness to participate in the study.
Functionally independent subjects were selected in order to collect
accurate information from the prepared questionnaire and life
All the participants and institution staff were informed about the
objectives and methodology of the study, and the study plan was
approved by the Ethics Committee of Marmara University. The
participants were evaluated by institution's physicians before the
study started. Individuals who had histories of significant
cardiovascular, pulmonary, metabolic and/or musculo-skeletal diseases
and/or psychiatric disorders were excluded. Among the 145 residents,
133 were eligible for the study, the participation rate being 92%.
There were no internal dropouts during the study.
Data were collected during face-to-face interviews. The
socio-demographic characteristics, health-related behaviors,
leisure-time activities and fall histories of the participants were
evaluated using a structured questionnaire.
The socio-demographic characteristics of the subjects were coded as
follows: gender (female = 1; male = 2); marital status (1 = never
married, divorced, widow/widower; 2 = married); level of education (1 =
no education, 2 = primary school, 3 = high school, 4 =
college/university); social security (1 = yes, 2 = no); and number of
children. Income status was classified according to the participants'
Physical activity (walking, callisthenic exercises) were assessed in
terms of frequency (sessions per week) and duration (minutes per
session). Participants undertaking physical activity at least 3 times
in a week with at least 30 minutes per session were classified as
physically active, while the rest were classified as physically
Smoking habits were classified as 'current', 'ex-', and
'non-smoker'. Alcohol use was classified into four categories;
abstainers, infrequent drinkers, moderate drinkers (1 or 2 glasses a
day) and excessive drinkers (more than 2 glasses a day).
Any participant who had had at least one fall during the past year was considered to have a 'positive' fall history.
The frequency of leisure time activities (handicrafts, reading,
gardening etc.) was categorized as " always", "frequently",
"sometimes", "rarely" or "never". Participants who took part in
leisure-time activities "always" or "frequently" were recorded as
having regular leisure-time activities.
Life satisfaction was assessed by the LSI-A satisfaction index,
which was first prepared, validated and published by Neugarten et al. 
and was adapted and translated into Turkish by Karatas in 1988 as a
highly reliable and valid index for the Turkish elderly population [33,34].
The internal consistency reliability coefficient (Cronbach's alpha) was
computed at 0.66 for LSI-A in our study group, which was slightly below
the lowest acceptable level (< 0.70). The LSI-A comprised twenty
items, of which twelve were positively worded. The answers "disagree",
"don't know" and "agree" were assigned as 0, 1 and 2 points
respectively. Eight items were negatively worded, with 0 assigned to
the "agree" answer. The total score obtainable from the LSI-A ranged
between 0 and 40 points.
The collected data were analyzed using the SPSS 11.5 software
package. Parametric tests of significance such as analysis of variance
(ANOVA) and unpaired t tests were used for group comparisons. Linear
regression models were constructed to determine LSI-A predictors. The
variables which were found to be significantly related to LSI-A by
univariate analysis, income level, regular physical and leisure time
activity, were included in a multivariate analysis. The critical value
for significance in all analyses was 0.05 (p < 0.05).