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The aim of this cross-sectional study was to investigate the links between …

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- The links between health-related behaviors and life satisfaction in elderly individuals who prefer institutional living

One of the main features of the world population in the late 20th and early 21st centuries has been the considerable increase in absolute and relative numbers of the elderly in both developed and developing countries. According to the World Health Organization, the number of elderly worldwide in 2004 was approximately 580 million and this figure is expected to increase in the coming years [1]. The percentage of people over the age of 65 in Turkey in 1990 was 4.3%, and this figure rose to 5.8% in 2003 and is estimated to represent 9.8% of the total population by 2025 [2,3]. Turkey tends to be a traditional culture with a collectivist orientation. The social structure is based on close-knit family relationships. Children and other relatives are expected to provide for the needs of older adults [4]. Therefore, only a small minority (approximately 4%) of the elderly population prefer institutional care [5]. However, the demand for institutional care has been increasing owing to the economic and medical problems of the older population, changing family lifestyles and the scarcity of available institutional services. It is notable that those who prefer institutional care are usually widowed, divorced or never married, have no children or close relatives, and are in the low-income bracket [3,6,7]. Nearly three out of every five elderly people living in institutions have low income status [5].

As an overview, the total bed capacity of institutions in the country that accept people aged 60 or over is approximately eighteen thousand, and such institutions can currently be classified into two groups: the first can be termed 'Elderly Care and Rehabilitation Centers', established for older people functionally dependent in respect of Activities of Daily Living (ADL) (bathing, dressing, continence, feeding, ambulation, etc); the second can be termed 'Nursing Homes', established for the elderly who are functionally independent or partially independent but need some assistance and supervision in ADL. Psycho-social services, basic health services, leisure time activities etc. are provided to the residents who are admitted to the institutions by nurses, social workers, psychologists and handicraft and sports instructors [5,8].

It is obvious that the social and medical problems of the elderly, whose population is increasing rapidly in Turkey, will become an important issue in the near future. In addition to longevity itself, quality of life is also important; this entails fulfillment of personal values and enjoyment of leisure time, and is influenced by physical, psychological, mental, social and economic circumstances [9,10]. As Ebersole [11] noted, the quality of life that leads to life satisfaction has become a reliable tool for investigating the efficiency of health care services and the effectiveness of rehabilitation programs.

The term 'quality of life' refers to an evaluation of the life conditions of a person, group or population. Objective or normative criteria can be used to measure quality of life, and these usually involve the quality of the physical and social environment, physical and mental health, and available support systems. However, subjective criteria, such as how the person considers his/her life, can also be used [12]. Subjective quality of life can be defined in terms of life satisfaction (LS), subjective well-being and happiness, etc. [12-14]. Life satisfaction, which includes factors such as health, education, interpersonal relationships and socio-economic status, is believed to be an evaluation of life in general [14].

Various studies have shown that limited ability to perform ADL also means decreased life satisfaction. For instance, among the elderly population in Sweden, those with reduced ADL capacity report several diseases and functional impairments that can cause low life-satisfaction [14]. Sato et al. [15] observed greater life satisfaction in Japanese pensioners living at home who had high levels of ADL.

There is a significant relationship between physical activity, functional status and health status in the elderly [16-18]. Decreases in these features are closely related to falls, which are a major problem area [19-23]. In addition, those who have had falls face the fear of falling again and tend to restrict their daily activities [22,24]. However, Laughton et al. [25] have reported that balance performance is not always a risk factor for elderly fallers; other factors should be considered, such as the risk levels in activities undertaken.

It has been reported that inactivity is also associated with greater behavioral risks and unhealthy lifestyles such as poor diet and smoking [26-28]. Tatum and colleagues [29] suggested detailed investigations into such health risks – unhealthy diet, excessive alcohol and tobacco consumption, lack of regular physical exercise, etc. – for promoting health in the elderly and for a significant change in their lifestyle in the nursing home. Health promotion in older people is a relatively new concept in geriatric care, and its importance has increased because of studies reporting that health-related behaviors could decrease the risk of secondary disabilities [30,31].

As far as we know, there are no data in the literature regarding life satisfaction status and health related behaviors, or the association between these two, in elderly residents of nursing homes in Turkey. There seems to be a need for additional investigation of the links between the health-related risks and life satisfaction among these residents. Thus, the aim of this cross-sectional study was to investigate the association between life satisfaction and health activities amongst functionally independent residents of nursing homes.

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