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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

Life satisfaction among the elderly has become an important issue in geriatric care [12-14]. The prevailing literature shows that it is affected by various physical, emotional, social and mental conditions [11,35]. Iwatsubo and colleagues [36] reported a significant relationship between life satisfaction and physical disabilities, leisure-time activities, marital and mental health status and family relationships amongst retired people in France. The results of our study also indicate a significant relationship between life satisfaction and involvement in regular physical and leisure-time activities. We also observed significantly lower life satisfaction scores in those with low incomes than in those with moderate and high incomes. The overall mean LSI-A score of our study group was 20.3 ± 5.9, which was lower than that (24.2 ± 4.4) reported by Iwatsubo et al. [36]. It can be argued that the differing results from different countries may be linked to differences in socio-cultural circumstances and demographic profiles. McConatha et al. reported that studies regarding life satisfaction of Turkish elderly population are few in number [4]. Imamoglu and Imamoglu [37] also compared Turkish respondents with those of a comparable Swedish sample. The findings of their cross-cultural study reported that, although Turks had more social contact with their relatives and neighbors, they had more negative attitudes about aging, felt lonelier, and had lower life satisfaction than Swedes. These authors also speculated that a decrease in satisfaction with social contacts may result in urban contexts, lowering life satisfaction for Turkish elderly.

However, in Turkey, Subasi and Hayran [38] found higher LSI-A scores (mean: 25.2 ± 5.5) than ours, which may be attributable to socio-cultural differences, vis-à-vis higher education and income levels, of the participants in the two studies. It may therefore be concluded that socioeconomic and educational variables are important factors in measuring the life satisfaction of the elderly both nationally [38] and internationally [39,40].

The mean LSI-A score for the physically active individuals in our study group was significantly higher than for those who led comparatively sedentary life styles (p = 0.01), a finding that is consistent with several other reports [35,41,42]. A previous study showed that daily walks, callisthenic exercises and/or Tai-Chi amongst nursing home residents were associated with higher life satisfaction scores [43]. Similarly, Subasi and Hayran [38] reported higher life satisfaction scores for elderly people who take part in regular recreational activities. The multivariate analysis of our data showed that leisure-time activities and regular physical activities were significant predictors of LSI-A scores. Thus, these results suggest the importance of encouraging the residents of nursing homes to take part in regular physical and/or leisure-time activities.

Regular physical activity as an important component of successful aging produces significant health benefits: it improves the health and functional status of the elderly [17] and also decreases the number of falls [20,21]. Approximately 30% of over-65s suffer at least one fall a year [20-23]. Elderly residents of nursing homes face a higher rate of falls because of nursing home settings and impaired functional capacities [21,23]. Nonetheless, in our study, the annual rate of falls (21.8%) was lower than others have reported. We believe that the low fall rate of our study group may be related to the restriction of our study to those who were ADL-independentand had sufficient cognitive functions.

Although life expectancy at birth is higher for females (74.4 years) than males (69.2 years) in Turkey, and elderly females slightly outnumber males in the population [3,44], more males thanfemales were included in our study group. In Turkey, approximately 65% of elderly living in the institutions is aged between 60 and 79 years [4]. It has been pointed out that Turks are generally more unfavorable toward institutional living [4,37]. It has also been implied that there are significant cultural differences between Turkey and western countries, which extend to attitudes toward aging and older adults. Turkey can be said to be a more collectivist culture. The studies indicated that older adults still hold considerable prestige and are valued and respected in Turkey [4]. Thus, only a relatively small percentage of the elderly population prefers to live in institutions in Turkey compared to industrialized western countries [44].

Generally speaking, most Turkish elderly either live alone in their homes in close proximity to their children or together with their married children [3]. However, Turkish males have more social network interactions than Turkish females. Relative to males, females are more often in relationships with their children, parents, and neighbors [44]. Compared to males, elderly females in particular are more frequently invited to live with their children and are rarely left to live alone [3]. Therefore, 60% of elderly people living in institutions in Turkey are male [5]. This might explain the higher proportion of males in our study, indicating a different aspect of the cultural and social structure of the country.

Acculturation is increasingly becoming an integral function of nurses and administrators in care organizations for elderly [45]. Therefore, the trends in Turkey in searching for alternative health care services for elderly people are becoming an important issue, similar to western countries.

Like any study, ours has some limitations. The first is the size and selection of the sample. Since our sample was selected from amongst the residents of a publicly owned institute in Istanbul, generalizing our findings to the entire Turkish elderly population may be somewhat tenuous. Also, our findings should be carefully interpreted in view of the slightly lower internal consistency (Cronbach's Alpha = 0.66) of the LSI-A in our study group.

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