The Impact of Middle-Aged Women’s Social Relations and Health Behavior on Perceptions of Successful Aging
Miyoung Lee
1, Mi-kyoung Lee*
2, Minkyoung Lee
3, Hongmee Lee
41 Associate Professor, College of Nursing, Eulji University, Gyeryong-ro 77, Junggu, Daejeon, 34824, Republic of Korea
*2Associate Professor, College of Nursing, Eulji University, Gyeryong-ro 77, Junggu, Daejeon, 34824, Republic of Korea
3Ph.D.student, College of Nursing, Eulji University, Gyeryong-ro 77, Junggu, Daejeon, 34824, Republic of Korea
4Undergraduate, College of Nursing, Eulji University, Gyeryong-ro 77, Junggu, Daejeon, 34824, Republic of Korea [email protected]1, [email protected]*2, [email protected]3, [email protected]4
Corresponding author*:
Mi-kyoung Lee,
[email protected]Abstract
Background/Objectives: Successful aging is a multi-dimensional concept. Most elderly people have chronic diseases
and efforts are needed for a successful approach to old age.
Methods/Statistical analysis: To investigate the impact of middle-aged women’s social relations and health behavior
on their perceptions of successful aging, 210 middle-aged women were recruited via convenience sampling; data of 191 participants were included in the final analyses. Analysis included a T-test, ANOVA, Pearson’s correlation coefficient, and multiple regression.
Findings: The results show that the mean scores for the participants’ social relations was 42.57 points, health
behavior was 123.01 points, and successful aging score was 111.92 points. Factors that affected the middle-aged women’s successful aging were health behavior, marital status, and occupation. These variables explain 27.0% of the variance in the middle-aged women’s perceptions of successful aging; health behavior is the most influential factor of these three elements.
Improvements/Applications: To increase middle-aged women’s perceptions of successful aging, it is necessary to
improve their health behavior, provide information to help with successful aging of the vulnerable population
Keywords: Middle-aged, women, Social relations, Aging, Health behavior,
1. Introduction
As average life expectancy lengthens, due to advances in medical technology and improvements in living standards, old- age among modern humans grows increasingly longer[1]. As both individual and social perceptions shift towards a greater appreciation and desire for improved quality of life, interest in successful aging is expanding. The concept of successful aging refers to an individual enjoying a healthy and happy life in one’s old-age, rather than seeing it as a simple extension and prolongation of life expectancy. Successful aging is a multi-dimensional concept encompassing a harmony between: high-level cognitive ability and physical function; non-disease and low disability; and an attitude of actively living life[2]. However, given that most elderly people suffer from various chronic diseases, and experience discomfort in their daily lives as a result of these diseases[3], concerted efforts need to be taken by middle-aged individuals in order to start preparing for a healthy and happy life and to enable successful old-age[4].
Middle-age is a period in the human life cycle that transitions from the early adulthood to the elderly. It is simultaneously the peak of the life cycle and the beginning of physical and cognitive aging – such as the manifestation of back and joint pain and memory loss[5]. In particular, middle-aged women are affected by various health problems caused by menopausal hormonal changes, and many prior studies report menopause-related health problems – such as fever, weight gain, depression, and cardiovascular disease[5]. Increasing health behavior can not only prevent disease, but can also decrease middle-aged women’s menopausal symptoms and level of depression while improving their self-perceived health status[6]. In order to be healthy and happy life throughout old-age, it is necessary to manage, maintain, and enhance one’s own health through health behaviors during one’s middle-age.
During middle-age adulthood, people experience psychological health problems, such as depression (due to the reduction in their social role) and conflict – as they experience their children's independence, retirement, unemployment, and difficulty with reemployment[5]. Active participation in life is the most important of the three factors of successful aging, and includes social relations and participation in productive activities that create social value[2]; social resources, in turn, have a positive influence on successful aging[7]. Considering this, social relations in one’s middle age can be considered as a powerful
contributor for successful aging.
As such, this study aims to help improve the quality of women’s life throughout old-age by identifying the impact of their social relations and health behavior on perceptions of successful aging.
2. Materials and Methods
2.1. Research design
This study is a descriptive survey research which aims to identify factors that affect middle-aged women’s perceptions of successful aging.
2.2. Research participants and data collection
Middle-aged women – women in their 40s to 60s – were recruited via convenience sampling of the parents and friends of college students attending E University in D City. Those who consented to participate were selected and surveyed. The sample size necessary for research was calculated using the G*Power 3.1 program, using an effect size = 0.15, significance level (α) = 0.05, power = 0.95, and 13 predictors. The results show that the sample size of 189 was needed; subsequently, and considering a drop- out rate of 10%, 210 participants were surveyed. After excluding 19 surveys with incomplete answers, a total of 191 surveys were included in the final analyses. Before distributing the surveys, explanations concerning the entire research process were provided and consent was obtained. It was explained that the participants may terminate their participation at any time and that their identities were held confidential. The surveys were anonymized; furthermore, only the researchers can view the surveys.
Participants who completed the surveys were provided with a small reward.
2.3. Research tools 2.3.1. Social relations
To measure middle-aged women’s social relations, the Social Relations Network Scale was used
[8]
. This scale comprises both structural and functional characteristics. The functional characteristics were revised and supplemented to fit the intent of this study.The concerning functional characteristics are comprised of a total of 12 items regarding emotional support, informational support, instrumental support, and social support. The items presented are assessed and answered via a 5-point Likert scale of: “Strongly disagree”, “Disagree”, “Neutral”, “Agree” and “Strongly agree”. Higher scores indicate greater positive social relations. The reliability of the original scale was measured as .909 (Cronbach’s α)
[8]
while the reliability of the scale used in this study is .88 (Cronbach’s α).2.3.2. Health behavior
The “Health Promoting Lifestyle Profile II” (HPLP II)
[7]
was translated into Korean and revised to form the health promotion lifestyle scale used in this study[9]
. This scale is comprised of a total of 50 items. The items are scored via a 4-point Likert scale, ranging from “Never” (1 point) to “Routinely” (4 points). Higher scores indicate a greater level of health behaviors. The reliability of the tool translated into Korean has a Cronbach’s alpha of .92[9]
, whereas the reliability of the adjusted scale used in this study has a Cronbach’s alpha of 0.96.2.3.3. Perceptions of successful aging
The revised and supplemented perceptions of successful aging scale was used in this study
[10]
. The scale was revised and supplemented to fit the intent of this study. This scale is comprised of 33 items across 6 domains. Each item is scored on a scale ranging from “Not important at all” (1 point) to “Very important” (4 points), with higher scores indicating higher perceptions of successful aging. The scale used in this study has a Cronbach’s alpha (as a measure of reliability) of .95.2.4. Data analysis methods
The data collected in this study were analyzed using the SPSS win 25 statistical program.
1) The participants’ general characteristics, social relations, health behavior, and perceptions of successful aging were analyzed in terms of frequencies, percentages, means, and standard deviations.
2) Health behavior, social relations, and perceptions of successful aging (according to the participants’ general characteristics) were analyzed with t-test and ANOVA methodology; Scheffe’s test was used for post-hoc testing.
3)
The correlations among health behavior, social relations, and perceptions of successful aging were analyzed using Pearson's correlation coefficients.4)
For factors affecting middle-aged women’s perceptions of successful aging, Multiple Regression Analysis was used.3. Results and Discussion
3.1. General characteristics of the participants
The most common age group among the participants is 46 to 50 (32.5% – 62 participants), while 90.6% (173 participants) were married at the time of the survey. 90.6% (173 participants) had children; 41.9% (80 participants) followed no religion; 81.7%
(156 participants) were workers; and 56.0% (107 participants) had at least graduated from college. The most common average income level was 4 million KRW (52.4% – 100 participants). 57.1% (109 participants) of participants stated that they had “normal”
standards of living. The most common activity engaged in one’s spare time was “Resting” for 45.5% (87 participants), followed by “Social participation activity” for 14.1% (27 participants), “Exercise” for 22.5% (43 participants), and “Others” for 17.8% (34 participants). 37.4% (71 participants) had experienced menopause<Table 1>.
Table 1. General characteristics of the participants
(n=191)
Characteristics Categories n (%)
Age (yr)
40~45 51 (26.7)
46~50 62 (32.5)
51~55 43 (22.5)
56~60 35 (18.3)
Marital status Married 173 (90.6)
Unmarried 18 (9.4)
Children Yes 173 (90.6)
No 18 (9.4)
Religion
Christianity 44 (23.0)
Buddhism 45 (23.6)
Catholic 22 (11.5)
No Religion 80 (41.9)
Educational level
Middle school or and lower 7 (3.7)
High school 77 (40.3)
College or and higher 107 (56.0)
Occupation Housewife 35 (18.3)
worker 156 (81.7)
Average income (10,000won/month)
200< 26 (13.6)
200~<300 30 (15.7)
300~<400 35 (18.3)
400≤~ 100 (52.4)
Standards of living
Dissatisfaction 32 (16.8)
Normal 109 (57.1)
Satisfaction 50 (26.2)
Spare time
Resting 87 (45.5)
Social participation activity 27 (14.1)
Exercise 43 (22.5)
Others 34 (17.8)
Menopause Yes 71 (37.4)
No 119 (62.6)
3.2. Participants’ social relations, health behavior, and perceptions of successful aging
The social relations score of the research participants range from 27 to 60 points, with a mean of 42.57±6.34. The health behavior score ranged between 76 and 200 points for a mean of 123.01±22.48. The perceptions of successful aging score ranges between 74 and 132 points for a mean of 111.92±12.11<Table 2>.
Table 2. Participants’ social relations, health behavior, and perceptions of successful aging (N=191)
Variables Min Max Total Items
Mean±SD Mean±SD
Social relations 27 60 42.57±6.34 3.55±0.53
Health behavior 76 200 123.01±22.48 2.46±0.45
Successful aging 74 132 111.92±12.11 3.39±0.37
3.3. Differences in social relations, health behavior, and perceptions of successful aging according to the general characteristics of the participants
T-test and ANOVA were used to test the differences in social relations, health behavior, and perceptions of successful aging according to the general characteristics of the participants. For post-hoc evaluation, Scheffe’s test was used. For differences in social relations according to the general characteristics of the participants, statistically significant differences are apparent according to the participants’ religion (F=3.44, p=.018) and their level of education (F=3.37, p=.037). For health behavior, there are statistically significant differences apparent according to participants’
average income (F=-3.84, p=.011) and spare time (F=4.07, p=.008). Finally, for perceptions of successful aging, there are statistically significant differences present according to the participants’ marital status (t=2.74,
p=.013) andoccupation (t=3.10, p=.002) <Table 3>.
Table 3. Difference between social relations, health behavior, and perceptions of successful aging according to the general characteristics of the participants
(N=191) Characteristics Categories
Social relations Health behavior Successful aging M±SD t or F(p) M±SD t or F(p) M±SD t or F(p)
Age (yr)
40~45 3.62±0.56
1.34(.264)
2.47±0.43
1.76(.157)
3.41±0.37
0.11(.955)
46~50 3.46±0.46 2.37±0.47 3.37±0.39
51~55 3.63±0.62 2.57±0.48 3.41±0.32
56~60 3.51±0.53 2.49±0.39 3.39±0.40
Marital status Married 3.55±0.53
-0.27(.788) 2.48±0.45
1.39(.165) 3.42±0.34
2.74(.013)
Unmarried 3.58±0.48 2.32±0.47 3.10±0.51
Children Yes 3.54±0.53
-0.90(.370) 2.47±0.45
0.36(.721) 3.41±0.35
1.72(.102)
No 3.66±0.50 2.43±0.43 3.22±0.48
Religion
Christianitya 3.67±0.48
3.44(.018) b<c
2.51±0.51
2.20(.090)
3.43±0.37
1.24(.297)
Buddhismb 3.42±0.43 2.41±0.39 3.32±0.37
Catholicc 3.77±0.56 2.66±0.45 3.48±0.36
No religiond 3.50±0.56 2.41±0.44 3.39±0.36
Educational level
Middle school
or and lower 3.57±0.71
3.37(.037)
2.45±0.37
1.82(.165)
3.41±0.33
0.98(.377)
High school 3.43±0.50 2.39±0.41 3.35±0.36
College or and
higher 3.63±0.52 2.52±0.48 3.42±0.37
Occupation Housewife 3.52±0.60
0.43(.666) 2.48±0.37
-0.26(.792) 3.22±0.39
3.10(.002)
Worker 3.56±0.51 2.46±0.47 3.43±0.35
Average income
200<a 3.41±0.42
2.38(.071)
2.22±0.42
3.84(.011) a<d
3.32±0.32
1.80(.149)
200~<300b 3.39±0.53 2.41±0.39 3.30±0.48
300~<400c 3.66±0.53 2.48±0.39 3.37±0.33
400≤~d 3.60±0.54 2.54±0.48 3.45±0.35
Standards of living
Dissatisfaction 3.40±0.53
2.15(.119)
2.38±0.44
2.52(.083)
3.50±0.41
1.69(.188)
Normal 3.56±0.54 2.43±0.47 3.37±0.35
Satisfaction 3.64±0.47 2.58±0.39 3.37±0.37
Spare time
Restinga 3.56±0.51
2.44(.066)
2.36±0.48
4.07(.008)
3.41±0.35
0.44(.723) Social participation activityb 3.77±0.58 2.60±0.43 3.42±0.36
Exercisec 3.46±0.52 2.61±0.32 3.37±0.33
Othersd 3.46±0.48 2.44±0.46 3.34±0.46
Menopause Yes 3.65±0.51
1.95(.053) 2.52±0.45
1.38(.170) 3.37±0.38
-0.63(.527)
No 3.50±0.53 2.43±0.45 3.41±0.36
3.4. Correlation among social relations, health behavior, and perceptions of successful aging of the participants
The results observed from the analyses of the correlation between social relations, health behavior, and perceptions of successful aging (of the participants) are shown in Table 4. Successful aging exhibits positive correlations with social relations (r=.31, p<.001) and health behavior (r=.41, p<.001). Furthermore, it was found that social relations have a positive correlation with health behavior (r = .60, p<.001).
Table 4. Correlation among social relations, health behavior, and perceptions of successful aging of the participants (N=191)
Variables Social relations Health behavior Successful aging
Social relations 1
Health behavior .60**
(<.001) 1
Successful aging .31**
(<.001)
.41**
(<.001) 1
3.5. Factors that affect the participants’ perceptions of successful aging
To examine the factors that affect participants’ perceptions of successful aging, marital status, occupation, and smoking (which showed significant differences among the general characteristics) were converted to dummy variables; multiple regression analysis was subsequently performed on these variables. The results of testing the multicollinearity of the independent variables show that the tolerance of each variable ranges between 0.63 and 0.99 (which are above 0.1), whereas the variance inflation factor (VIF) ranges between 1.01 and 1.58, which does not exceed the threshold of 10. Thus, there are no observable problems of multicollinearity. There result of the Durbin-Watson test, which shows the independence of error terms, is 2.183 – which is close to 2. Thus, it was confirmed that there are no autocorrelations among the error terms, indicating that regression analysis is appropriate. The regression model is significant (F=18.57, p<.001). In terms of the factors that affect the perceptions of successful aging, it was found that the largest predictors are in the order of health behavior (β=0.32, p<.001), marital status (β=-0.25, p<.001), and occupation (β=-0.24, p<.001). Furthermore, health behavior is the factor that has the greatest impact on successful aging, explaining 27.0% of the variance.
Table 5. Factors that affect the participants’ perceptions of successful aging
(N=191)
Variables B SE β t p VIF
(Constant) 2.53 0.16 15.70 <.001
Social relations 0.08 0.05 .12 1.52 .131 1.57
Health behavior 0.26 0.06 .32 4.11 <.001 1.58
Marital status(Unmarried) -0.31 0.08 -.25 -3.94 <.001 1.02
Occupation(Housewife) -0.22 0.06 -.24 -3.81 <.001 1.01
R2=.285, Adjusted R2=.270, F=18.57(P<.001) Durbin-Watson’s d=2.183
With the increase in the average life expectance of women, the interest in, and importance of, their perceptions concerning successful aging is growing. As such, preparation prior to reaching old age is necessary. Thus, this study was conducted to identify factors affecting middle-aged women’s perceptions of successful aging in terms of social relations and health behavior.
First, the mean score concerning the perceptions of successful of middle-aged women (who participated in this study) is 3.39 out of 4 points. This is similar to the previous study, which found that the successful aging score among middle-aged women – as measured with the identical scale – is 4.11 out of 5 points, on average[10]. This is comparable to results observed in a previous study which used a similar scale to test the perceptions of successful aging in the same population, which exhibited an average score of 4.00 out of 5 points[11]. In general, Korean middle-aged women’s perceptions of successful aging is above average, and there are differences in the scores between perceptions of successful aging depending on the individual’s marital status (t=2.74, p=.013) and occupation (t=3.10, p=.002). This is different from previous results, showing that there are no significant differences in the perceptions of successful aging as mediated by the individual’s marital status or occupation[10]. Results do show that there are differences in the perceptions of successful aging by level of education, primary income source, and subjective health status[10].
This signifies that middle-aged women’s perceptions of successful aging, as mediated along the lines of general characteristics, can
differ depending on whether the participants are in their early or late middle-age – as such, additional research is necessary.
Social relations scored 3.55 points out of 5 points, which is above average. There are observable differences apparent depending on the religion (F=3.44, p=.018) and level of education (F=3.37, p=.037) of the participant. In terms of social relations, the concept of social support is generally reflected. Therefore, the results of this study are further comparable to the results of previous research which measured social support among middle-aged women. In a previous study, the friend and peer support among middle-aged women was recorded as 3.63 out of 5 points, whereas family support scored 4.38[11], which was partially similar to the results of this study. Health behavior scored 2.46, on average, out of 4 points, which is similar to the 2.52 points from a previous study using the same scale[12]. Additionally, there are statistically significant differences apparent depending on the participant’s average income (F=-3.84, p=.011) and spare time (F=4.07, p=.008); this too was similar to previous findings[12]. The level of health behavior is greater when the participant’s average income is higher and when their spare time was spent on exercise or social participation activity (compared with resting in their spare time). Therefore, in order to improve middle-aged women’s health behavior, it is necessary to recommend using their spare time to engage in appropriate exercises or social participation activities.
Given the results of this study, health behavior is found to have the greatest impact as a variable that affects perceptions of successful aging. Furthermore, among general characteristics, a marital status of “unmarried” and the occupation of “housewife”
are found to affect the perceptions of successful aging. This supports the previous finding that there is a positive, moderate correlation between health behavior and perceptions of successful aging
[12]
and is in line with the finding that the level of perceived health status affects the perceptions of successful aging[13]
. Ultimately, perceiving oneself as healthy through various activities for health is an important factor improving perceptions of successful aging among middle-aged women who are preparing for old age. Therefore, various institutionalized advertisements that inform the importance of regular exercise and the abstaining from alcohol and smoking in order to welcome successful aging might be necessary. Being unmarried and being a housewife are factors that decrease the perceptions of successful aging scores. This is partially in agreement with a previous study that shows that, while marital status is not an influential factor, occupation does influence the perceptions of successful aging[13]
. These two are general characteristic variables and, therefore, direct intervention is not possible. However, for these groups, it will be possible to establish strategies to increase the perceptions of successful aging – such as connecting groups of similar situations, providing opportunities to communicate with each other, and receiving information. Providing information and communicating are ultimately related to support as well. In this study, social relations do not affect perceptions of successful aging, but the concept of social support has been asserted as being an important variable for perceptions of successful aging in many previous studies[7,13]
. Therefore, a replication study is recommended. Furthermore, efforts to positively perceive old age is not only necessary for women, but for men as well. Because this study was only conducted on middle-aged women, additional research on all middle-aged people (including men) is suggested.This study is limited in that it is necessary to interpret the results carefully given that it was conducted on a selection of participants in Korea via convenience sampling. However, since increasing the perception toward successful aging in light of an the aging society can reduce the burdens and tensions experienced by middle-aged women (concerning about old-age itself), it is important to identify factors that affect the perceptions of successful aging. Therefore, this study is significant in that it provides basic data necessary to establish plans for improving the perceptions of successful aging.
4. Conclusion
This study employed a descriptive survey methodology in order to identify the factors that affect middle-aged women’s perceptions of successful aging with a focus on their social relations and health behaviors. To identify middle-aged women’s perceptions of successful aging, general characteristics, social relations, and health behavior were used as independent variables in regression analyses. Subsequently, it is found that health behavior, marital status, and occupation are influential factors. These variables are found to explain 27.0% of the variance in the perceptions of successful aging. Furthermore, it is found that health behavior has the largest explanatory power among those variables. Therefore, strategies that can increase the health behaviors of middle-aged women can ultimately have a positive influence on improving their perceptions of successful aging. In conclusion, it is necessary to inform individuals of the importance of health behavior and to establish various programs so as to improve middle-aged women’s perceptions of successful aging. Furthermore, institutional efforts are necessary to improve the perceptions of successful aging among unmarried women and housewives.
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