Identifying the Effective Factors on Efficiency of Elderlies in Physical Activity (A Case Study: Elderlies in Ilam)
Sara Mohammadnejad
Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran.
Email:[email protected] Orcid:0000-0002-6835-0037
Hamid Heidarzadeh*
Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran.
Email:[email protected] Orcid Code:0000-0002-1192-6592
MahnazShafieian
Department of Midvifery, Faculty of Nursing and Midvifery, Ilam university of Medical Sciences,Ilam, Iran
Email:[email protected] Orcid:0000000215486571
AsadImani
Department of nursing.Faculty of nursing and midwifery.Ilam university of medical science.
Email:[email protected] orcid:0000-0002-6748-2986 Abstract
This study tends to identify the effective factors on efficiency of elderlies in physical activity using PLS model.The method is descriptive (non-trial) and correlational with structural equations using PLS; because this study examines the relationships between variables through a causal model.Participants included the elderlies living in nursing homes in Ilam. According to Cochran's formula, 234 elderly people living in nursing homes in Ilam were selected as statistical sample using simple random sampling. Among them, 234 questionnaires were distributed,of which 220 questionnaires were answered; of these, 14 questionnaires were excluded from the analysis because a large number of questions were unanswered. Finally, 220 questionnaires were analyzed. They answered the researcher-made questionnaires and its validity and reliability were calculated.Structural equation model with SMARTPLS software was used to analyze the data. Findings showed that the effect of individual factors is positive and significant on efficiency of elderlies in physical activity.The effect of social factors is positive and significant on efficiency of elderlies in physical activities. The effect of organizational factors is positive and significant on efficiency of elderlies in physical activities.The model explains 0.72 of variance in efficiency of elderlies in physical activity.
Keywords: efficiency, elderly, physical activities
Introduction
Due to the decrease in the number of marriages and births and improvement of health conditions, the number of elderly people has increased more in Iran. According to the head of the National Organization for Civil Registration, annual population growth in Iran is about 1.3 percent and in the world is 1.1 percent. The increase in the country's elderly population will reach 7.4 percent in 1405 and 18 percent in 1425.That means we will have one elderly person out of every 5 people in Iran. In the near future, we will certainly face the serious problems of the elderly and their problems, which requires special attention of authorities to the issue of aging(Amini, 2016).
Aging is a critical time. With age, elderly’s dependence on others in daily activities increases due to disorders that occur in different systems of the body, especially due to mobility limitations(Ouelletet al., 2016).On the other hand, studies show that physiological, structural, mental and emotional characteristics of elderlies are different from those of young and middle- aged people.Aging is a biological process, not a disease, although aging causes changes in the body that may limit the lifestyle a person has had in previous years.There are basically three main factors, health status, economic status, and social support, that affect life activities of the elderly (Gharaveis, 2020).
One of the reasons for necessity and importance of examining the situation of elderly is that the elderlies are exposed to various mental and physical diseases in old age, and this, in addition to imposing heavy costs ofcare and treatment of the elderly on the family, will have negative effects on other family members.Due to the fact that modern life is in apartments and small spaces, it is impossible to take care of the elderly. Eventually, referring to public and private care centers for the elderly will increase and this will cause heavy costs for the government(Amini, 2016).
Scientists believe that assessing and recognizing protective problems of elderlies, which includes assessing the effectiveness of medical and pharmaceutical interventions, assessing the level of physical and mental health, and assessing the level of physical safety of elderlies, are essential in order to achieve a healthier and longer life during this period as an important part of human life(Mohammadi, 2019).
Usually after retirement age, health disorders such as high blood pressure, heart disease, depression, stroke, diabetes, as well as vision and hearing loss and a variety of physical and mental illnesses appear.Due to retirement and reduced income, they gradually lose their self- confidence, become indifferent to their nutrition and health and feel overwhelmed; social support
from theirspouses, children, colleagues and friends plays an important role in their life. Balance and gait, which are associated with problems in old age, are considered as indicators of functional independence in daily affairs of the elderlies. Therefore, identifying the causes and consequences of gait problems in old age and effective methods in delaying the onset of gait problems are among the goals of elderly care.Naturally, with age, balance control and gait decline and lose their effectiveness (Carlson et al., 2020).One of the topics that sociologists have considered to fill leisure time is sports. Exercise as an exciting and motivating phenomenon which promotes health and unity and empathy in society, has an important place.Exercise and related activities play an important role in prevention of cardiovascular disease, hypertension, diabetes, depression and neurological diseases.One of the reasons for necessity and importance of studying the condition of elderlies is that elderlies are exposed to various mental and physical diseases in old age, and this, in addition to imposing heavy costs of care and treatment on the family, has negative effects on other membersof the family. Due to the fact that modern life is in apartments and small spaces, it is impossible to take care of the elderly. Eventually, referring to public and private care centers for the elderly will increase and this will cause heavy costs for the government (Castelli et al, 2020).
Ghamati (2015) identifies theeffective factors on continuous participation of elderlies in leisure physical activity and presented a model. According to the results, paying attention to quality of life of elderlies, motivating them to participate in sports, sharing the executive duties of the organizations in charge of sports for elderlies, creating culture and media advertising about sports for elderlies and providing inexpensive sports facilities for elderlies are effective measure that can play an important role in improving the participation of elderlies in physical activity.Mehtepet al. (2015) reviewed the level of healthy physical activity for elderlies living in nursing homes and conducted that working with elderlies and regular exercise reduce cardiovascular diseases and mental disorders in them and improve their level of physical health and social activity.Alarcón-Jiménezet al. (2020) determined the relationship between physical activity and emotional function of elderlies. In this study, 60 elderly people from different parts of Malaga participated.Cognition of emotional expression, working memory, body composition and physical activity were examined. The results showed that emotional function was not affected by age.There was a significant relationship between physical activity and working memory function; there was also a significant relationship between intense/very intense physical
activity and working memory.Therefore, physical activity can be directly related to emotional performance by having a positive effect on working memory.
Accordingly, the increase in leisure time of elderlies leads to a need for planning and providing the necessary facilities by researchers and authorities.Leisure as a cultural and social phenomenon influences economic, political and social dimensions and is a common subject of all sections of society, particularly elderlies, which has unfortunately been forgotten.The main problem of the present study is to determine effective factors on efficiency of elderlies in physical activities.
Materials and Methods
The method of the present study is descriptive (non-pilot) and correlational with structural equations using partial least square (PLS); because this study measures the relationships between variables through a causal model.As it is an applied research, PLS is more relevant to objectives of this study(China, Marcoline and Newstead, 1996). Participants included elderlies living in nursing homes in Ilam. According to Cochran's formula, 234 elderly people living in nursing homes in Ilam were selected as statistical sample using simple random sampling.Among them, 234 questionnaires were distributed, out of which 220 questionnaires were answered; of them, 14 questionnaires were excluded from the analysis because a large number of questions were remained unanswered.Finally, 220 questionnaires were analyzed. Based on literature review, the following conceptual model was considered as a conceptual model of the study.
Figure 1: conceptual model
Individual factors
Social factors
Organizational factors Efficiency in
physical activity
Data Collection Instruments
A researcher-made questionnaire was used to measure individual, social and organizational factors. This questionnaire consists of 15 items. Questions were measured on a five-point Likert scale (strongly disagree = 1 to strongly agree = 5).Internal consistency of this questionnaire was 0.88 using Cronbach's alpha.
Physical activity efficiency questionnaire was developed with 10 items and was graded on a five- point Likert scale.Likert scale is a kind of distance scale that uses five points of strongly disagree, disagree, neither agree nor disagree, agree, and strongly agree. Internal consistency of this questionnaire was obtained 0.79 using Cronbach's alpha method.
Dillon-Goldstein (ρc) coefficient was used to evaluate composite reliability of each construct.
Acceptable values of ρc must be 0.7 or higher.The third criterion for reliability is average variance extracted (Fornell&Larker, 1981). Fornell and Larker recommend AVE values of 0.50 and above, which means that the construct explains about 50% or more of the variance of its markers (Chin, 1988).Table 1 presents the factor loads, ρc, and AVE of the variables. Values of these tables indicate sufficient and appropriate reliability of the constructs.
Table 1: factor loads, composite reliability and average variance extracted of factor analysis of variables
variable n alpha ρc AVE
Individual Factors 220 0.88 0.85 0.52 Social Factors 220 0.79 0.83 0.54 Organizational Factors 220 0.90 0.91 0.55 Physical Activity Efficiency 220 0.81 0.83 0.60
To examine validity or discriminant validity of constructs, Chin (1988) recommends two criteria:
1)items of a construct should have maximum factor load on their construct;that is, they should have a small cross-sectional load on other constructs. Gefen and Straub (2005) suggest that the factor load of each item on its own construct should be at least 0.1 more than factor load of the same item on other constructs.2)Square root of AVE of a construct must be greater than correlation of that construct with other constructs. This indicates that the correlation of that constructwith its markers is greater than its correlation with other constructs.
Results
Findings related to demographic variables are listed in Table 2. Findings show that 55% of respondents are men and 45% of respondents are women.Regarding the frequency distribution of
the respondents by age, the findings showed that 37.72% of the respondents had middle school degree, 32.27% had high school diploma, 16.36% had a bachelor's degree, and 13.63% had a master's degree.
Table 2: demographic findings
variable n %
gender
male 121 55
female 99 45
education
middle school diploma 83 37.72 high school diploma 71 32.27 bachelor's degree 36 16.36 master’s degree 30 13.63
After calculating the descriptive indices of the variables, structural equation modelling was used to investigate the causal relationships between the variables.Table 3 reports the results of correlation and second criterion of validity, namely square root of AVE.
Table 3: matrix of correlation and square root of AVE of variables
variable 1 2 3 4
1. individual factors 1
2. social factors 0.30** 1
3. organizational factors 0.32** 0.41** 1 4. physical activity efficiency 0.40** 0.38** 0.32** 1
mean 3.21 3.83 3.95 3.78
standard deviation 0.70 1.003 0.97 0.98
According to Table 3, square root of AVE of all variables is greater than their correlation with other variables. Therefore, the second criterion is established for examining discriminant validity of variables.In addition, numbers below diagonal of the correlation matrix are reported to investigate the relationship between the variables. Obviously, the coefficient of correlation between variables is positive and significant.
To predict efficiency of elderlies in physical activity, the proposed conceptual model was examined through structural equation modelling, and according to the hypotheses, partial least squares method was used to estimate the model.Bootstrap method (with 500 sub-samples) was used to calculate T-values to determine the significance of path coefficients. Figure 2 shows the tested model of the relationship between the variables.
Figure 2: the tested model
According to Figure 2, the effect of individual factors is positive and significant on efficiency of elderlies in physical activity. Moreover, the effect of social factors is positive and significant on efficiency of elderlies in physical activities.The effect of organizational factors is positive and significant on efficiency of elderlies in physical activities. The model also explains 0.72% of variance in efficiency of elderlies in physical activities.Table 5 reports the estimated path coefficients and explained variance of the variables. The numbers in parentheses are T-values.
Table 4: path coefficients and variance explained
variable 𝛃 variance explained
on physical activity efficiency of elderlies vie:
individual factors social factors organizational factors
0.49**
0.31**
0.42**
0.72
* p<0.05; ** p<0.01
According to Table 4, 72% of the variance in efficiency of elderlies in physical activity is explained by the model.As shown in Table 5, positive values of CV-communalities and CV- redundancies for all variables indicate the appropriate and acceptable quality of the measurement and structural model.
Table 5: communalities and redundancies of variables
variable Q2
CV-Redundancy CV- Communality
1. individual factors - 0.695
2. social factors - 0.528
3. organizational factors - 0.519
4. physical activity efficiency 0.567 0.582
In addition to indicators in Table 5, the overall fit index of the model in PLS is GOF index and it can be used to check validity or quality of the PLS model in general.This index examines the overall predictive power of the model and whether the tested model was successful in predicting endogenous latent variables.In the present study, the absolute fit index of GOF was 0.49 for the tested model, and the value obtained for this fit index indicates the appropriate fit of the tested model.
Discussion and Conclusion
This study tended to identify the effective factors on efficiency of elderlies in physical activity through a case study on elderlies living in Ilam by using structural equations.The results showed that the proposed model fits relatively well with data of this study and can explain 0.72% of variance in efficiency of elderlies in physical activity.
The results of structural equations showed that impact factor of individual factors is positive and significant on efficiency of elderlies in physical activity. Moreover, the effect of social factors is positive and significant on efficiency of elderlies in physical activities.The effect of organizational factors is positive and significant on efficiency of elderlies in physical activities.
The model explains 0.72 of variance in efficiency of elderlies in physical activity.
To explain these findings, it can be argued that the risk of diseases and disabilities increases with age in the last years of life, and its negative effect on the ability to maintain independence increases the need for help.These problems, which occur naturally in old age, reduce the quality of life during old age; in Iran, 28% of elderlieshave limited physical activity and need help to perform normal life activities, which reduces their quality of life.Obviously, at older ages, the incidence of disabilities is more pronounced and appears in the form of reduced physical activity and physical limitations, and the incidence of chronic diseases increases in old age.In addition, employment, marriage, physical health and education are other variables that affect the quality of life of elderlies.Given that quality of life in this period can be easily threatened, it is important to
consider the underlying effective factors on quality of life of elderlies. One of the issues related to quality of life - especially for elderlies - is health status. Health, as defined by the World Health Organization, has physical, mental, social, and spiritual dimensions.The spiritual dimension of health is one of the dimensions of health that some experts believe it is necessary to pay serious attention to.In fact, without spiritual health, other biological, psychological and social dimensions cannot function properly or reach their maximum capacity, and as a result, the highest level of quality of life cannot be achieved.
In most societies, older people are most at risk for reduced physical, mental, and cognitive ability and are more likely to rely on formal or informal support to maintain health, function, and self- sufficiency.Problems of elderlies and adoption of right policies on them have now become a common global concern.The main difference between developed and developing countries is that developed countries are fully prepared to face the challenges posed by growing number of older people, but most developing countries are not even aware of this phenomenon and its health, social and economic troubles.
Findings of this study are consistent with Jalali (2018), Ghamati (2018), Mohammadi (2019), Mehtepet al. (2015) and Alarcón-Jiménezet al. (2020).
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